Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 59443 | MA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 59443 | MA |
NPI | 1588735765 |
---|---|
Provider Name | Anthony K Teebagy |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110045572A | (05) | MA |
A66613 | (02) | MA |