MEDICARE: THEODORE HARVEY ATKINSON

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	213E00000X	Podiatrist	1364	MA

General Provider Information

NPI Number	:	1821264607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEODORE HARVEY ATKINSON

Provider Business Mailing Address
First Line	:	462 TRAPELO RD
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-1421
Country	:	US
Telephone Number	:	617-484-0123
Fax Number	:	617-484-0123

Provider Business Practice Location Address
First Line	:	462 TRAPELO RD
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-1421
Country	:	US
Telephone Number	:	617-484-0123
Fax Number	:	617-484-0123

Authorized Official
Title or Position	:	OWNER
Name	:	THEODORE HARVEY ATKINSON
Credential	:	D.P.M
Telephone Number	:	617-484-0123

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/21/2008

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