Tedesco, Brian D

Tedesco, Brian D is an individual health care provider with primary practice located at 53 Main St , Somerville MA 02145-1448. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Tedesco, Brian D can be contacted via phone (617) 629-2304.

Contact Information

Primary practice address
53 Main St Somerville MA 02145-1448
Phone: (617) 629-2304
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 2199 Massachusetts
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 2199 Massachusetts

Profile Details

NPI number 1588628853
LBN Legal business name Tedesco, Brian D
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2006
Last updated Aug 31st, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588628853 NPPES
Massachusetts MEDICAID 0364011
Massachusetts Other 0032245
Massachusetts Other 11318840
Massachusetts Other 202648900
Massachusetts Other 972127
Massachusetts Other 2180343
Massachusetts Other 2180343
Massachusetts Other 334226
Massachusetts Other 746579
Massachusetts Other 002199
Massachusetts Other 96048
Massachusetts Other DB4378
Massachusetts Other Y71104

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