Healthcare Provider Details

I. General information

NPI: 1609920776
Provider Name (Legal Business Name): THEODORE TREIBICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CAMBRIDGE ST STE 100
BURLINGTON MA
01803-3769
US

IV. Provider business mailing address

417 ELK RUN RD
HUDSON NH
03051-3542
US

V. Phone/Fax

Practice location:
  • Phone: 781-272-9500
  • Fax: 855-870-4649
Mailing address:
  • Phone: 978-505-9897
  • Fax: 855-870-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number46320
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number46320
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: