NPIMap

Organization Active NPI

Tedesco Medical Associates, LLC

  • Psychiatry Physician
  • Worcester, MA
National Provider Identifier
1073990958
Registry record updated Apr 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
152283 Issued in MA
Legal business name
TEDESCO MEDICAL ASSOCIATES, LLC
Practice address
131 Lincoln St
Suite 8
Worcester, MA 01605-2408
Phone
(508) 762-4105
Fax
(508) 762-4106
NPI assigned
Apr 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eleanor Theresa Tedesco, M.D.NPI 1700930914
Title
Owner
Phone
(508) 762-4105

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 152283 MA Primary

Addresses

Primary practice location

131 Lincoln St
Suite 8
Worcester, MA 01605-2408

Mailing address

19 Wheelock Rd
Shrewsbury, MA 01545-1834
Phone (508) 845-6510

Other identifiers 1

IdentifierTypeStateIssuer
3178111MedicaidMA

Other names 1

  • E Theresa Tedesco MD Other name

National Provider Directory

National Provider Directory

Locations

131 Lincoln St
Ste 8
Worcester, MA 01605
Phone (508) 762-4105

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1073990958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 WHEELOCK RD",
            "city": "SHREWSBURY",
            "state": "MA",
            "postal_code": "015451834",
            "telephone_number": "508-845-6510",
            "fax_number": "508-845-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 LINCOLN ST",
            "address_2": "SUITE 8",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052408",
            "telephone_number": "508-762-4105",
            "fax_number": "508-762-4106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEDESCO MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "TEDESCO",
        "authorized_official_first_name": "ELEANOR",
        "authorized_official_middle_name": "THERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-762-4105",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "152283",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3178111",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "E Theresa Tedesco MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.