Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 46320 | MA |
NPI | 1609920776 |
---|---|
Provider Name | Theodore Treibick |
First Address | Carlisle, MA 01741-1105 |
Second Address | Carlisle, MA 01741-1105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 23/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110002031 | (05) | MA |