Healthcare Provider Details

I. General information

NPI: 1740960574
Provider Name (Legal Business Name): BRIAN D TEDESCO, DPM & GEORGE A ABBOUD, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MAIN ST UNIT 1
NASHUA NH
03060-2929
US

IV. Provider business mailing address

607 NORTH AVE DOOR 17
WAKEFIELD MA
01880
US

V. Phone/Fax

Practice location:
  • Phone: 603-459-8760
  • Fax: 603-459-8758
Mailing address:
  • Phone: 781-944-4044
  • Fax: 781-944-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SHEILA ANTIMONE
Title or Position: OFFICE MANAGER
Credential:
Phone: 781-944-4044