MEDICARE: MRS. TERESA DEGIACOMO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	60424	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070016619	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4292	OTHER		HARVARD PILGRIM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	724847	OTHER		TUFTS
5	J12059	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1245214311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA DEGIACOMO M.D.

Provider Business Mailing Address
First Line	:	90 LIBBEY PKWY
Second Line	:	SUITE 200
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-3129
Country	:	US
Telephone Number	:	781-335-9700
Fax Number	:	781-335-9709

Provider Business Practice Location Address
First Line	:	90 LIBBEY PKWY
Second Line	:	SUITE 200
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-3129
Country	:	US
Telephone Number	:	781-335-9700
Fax Number	:	781-335-9709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	06/19/2008

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Directions to “ MRS. TERESA DEGIACOMO M.D.” Practice Location

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