Provider Demographics
NPI:1336557958
Name:JORGE E TELLO MD PC
Entity Type:Organization
Organization Name:JORGE E TELLO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-302-3343
Mailing Address - Street 1:21 SCHOOL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6640
Mailing Address - Country:US
Mailing Address - Phone:617-302-3343
Mailing Address - Fax:617-481-4655
Practice Address - Street 1:21 SCHOOL ST
Practice Address - Street 2:STE 1
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6640
Practice Address - Country:US
Practice Address - Phone:617-302-3343
Practice Address - Fax:617-481-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty