Provider Demographics
NPI:1780628768
Name:SPIELBERG, THEODORE E (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:E
Last Name:SPIELBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 WASHINGTON ST
Mailing Address - Street 2:STE. 245
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6219
Mailing Address - Country:US
Mailing Address - Phone:781-235-3460
Mailing Address - Fax:781-235-9621
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:STE. 245
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:781-235-3460
Practice Address - Fax:781-235-9621
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29018207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0190381Medicaid
MA0190381Medicaid
MAC25078Medicare ID - Type Unspecified