Healthcare Provider Details

I. General information

NPI: 1952503831
Provider Name (Legal Business Name): THEODORE E. SPIELBERG, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 WASHINGTON ST STE. 245
WELLESLEY HILLS MA
02481-6219
US

IV. Provider business mailing address

332 WASHINGTON ST STE. 245
WELLESLEY HILLS MA
02481-6219
US

V. Phone/Fax

Practice location:
  • Phone: 781-235-3460
  • Fax: 781-235-9621
Mailing address:
  • Phone: 781-235-3460
  • Fax: 781-235-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number29018
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE E. SPIELBERG
Title or Position: PRINCIPAL PHYSICIAN
Credential: M.D.
Phone: 781-235-3460