Provider Demographics
NPI:1922005511
Name:ATKINSON, THEODORE H (DPM)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:H
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 TRAPELO RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1421
Mailing Address - Country:US
Mailing Address - Phone:617-484-0123
Mailing Address - Fax:617-484-3337
Practice Address - Street 1:462 TRAPELO RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1421
Practice Address - Country:US
Practice Address - Phone:617-484-0123
Practice Address - Fax:617-484-3337
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1364213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1225970001OtherMEDICARE NSC
MA0300624Medicaid
MA1225970001OtherMEDICARE NSC
MAT58649Medicare UPIN