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General NPI Number Information
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NPI Number | 1609920776
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Entity Type | Individual
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Provider Name | THEODORE TREIBICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 101 CAMBRIDGE ST STE 100
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City | BURLINGTON
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State | MA
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Zip | 01803-3769
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Country | US
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Telephone | 781-272-9500
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Fax | 855-870-4649
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Provider Business Mailing Address
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Address Line | 417 ELK RUN RD
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City | HUDSON
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State | NH
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Zip | 03051-3542
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Country | US
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Telephone | 978-505-9897
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Fax | 855-870-4649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 46320
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 46320
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License Number State | MA
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