Provider Demographics
NPI:1982715140
Name:BURTOFT, TERESA JEAN (DPM)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JEAN
Last Name:BURTOFT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5044
Mailing Address - Country:US
Mailing Address - Phone:978-686-7623
Mailing Address - Fax:978-683-9911
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5044
Practice Address - Country:US
Practice Address - Phone:978-686-7623
Practice Address - Fax:978-683-9911
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2106213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY75058Medicare PIN
MAU74569Medicare UPIN
MA4629520001Medicare NSC