Individual
BRIAN D TEDESCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
53 MAIN ST, SOMERVILLE, MA 02145-1448
(617) 629-2304
Mailing address
PO BOX 2190, WEST PEABODY, MA 01960-7190
(781) 231-7026
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
2199
MA
213ES0131X
Foot Surgery Podiatrist
2199
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002199
TUFTSHEALTH CARE
MA
01
—
0032245
NEIGHBORHOOD HEALTH
MA
05
—
0364011
—
MA
01
—
11318840
CAQH
—
01
—
202648900
DEPT. OF LABOR-WC
—
01
—
2180343
HEALTHCARE VALUE
MA
01
—
334226
HARVARD PILGRIM HEALTH
MA
01
—
746579
CIGNA
MA
01
—
96048
FALLON
MA
01
—
972127
NETWORK HEALTH
MA
01
—
DB4378
RAILROAD MEDICARE
MA
01
—
Y71104
BLUE CROSS/BLUE SHIELD
MA
Enumeration date
04/13/2006
Last updated
08/31/2011
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