Healthcare Provider Details

I. General information

NPI: 1154492700
Provider Name (Legal Business Name): TRISTAN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 W MAIN ST STE 2
NORTON MA
02766-1241
US

IV. Provider business mailing address

184 W MAIN ST STE 2
NORTON MA
02766-1241
US

V. Phone/Fax

Practice location:
  • Phone: 508-824-0243
  • Fax:
Mailing address:
  • Phone: 508-824-0243
  • Fax: 774-202-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMA

VIII. Authorized Official

Name: JULIE S. THIBERT
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 508-824-0243