MEDICARE: THEODORE H ATKINSON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	1364	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1225970001	OTHER	MA	MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922005511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE H ATKINSON DPM

Provider Business Mailing Address
First Line	:	462 TRAPELO RD
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-1421
Country	:	US
Telephone Number	:	617-484-0123
Fax Number	:	617-484-3337

Provider Business Practice Location Address
First Line	:	462 TRAPELO RD
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-1421
Country	:	US
Telephone Number	:	617-484-0123
Fax Number	:	617-484-3337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/28/2008

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