Healthcare Provider Details

I. General information

NPI: 1841154879
Provider Name (Legal Business Name): THEODORE P FECHTMEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 MEMORIAL DR
CAMBRIDGE MA
02138-6123
US

IV. Provider business mailing address

1098 SUNBURST LN
MIDWAY UT
84049-6488
US

V. Phone/Fax

Practice location:
  • Phone: 612-501-2050
  • Fax:
Mailing address:
  • Phone: 612-501-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE931973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: