Organization
GEORGE H. THEODORE, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE H THEODORE M.D. (OWNER)
(617) 726-1344
Entity
Organization
Contact information
Practice address
175 CAMBRIDGE ST, 4TH FLOOR, BOSTON, MA 02114-2743
(617) 724-7009
(617) 643-1006
Mailing address
175 CAMBRIDGE ST, 4TH FLOOR, BOSTON, MA 02114-2743
(617) 724-7009
(617) 643-1006
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
150940
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
173652
HPHC
MA
01
—
727867
TUFTS
MA
05
—
9730290
—
MA
01
—
M18225
BCBS MA
MA
Enumeration date
10/07/2005
Last updated
10/14/2014
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