Manschreck, Theo Clyde
Manschreck, Theo Clyde is an individual health care provider with primary practice located at 59 Outlook Drive , Lexington MA 02421-9637. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Manschreck, Theo Clyde can be contacted via phone (781) 863-2304.Contact Information
Primary practice address
59 Outlook Drive
Lexington MA 02421-9637
Phone: (781) 863-2304
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 35291 | Massachusetts |
Profile Details
| NPI number | 1700867595 |
|---|---|
| LBN Legal business name | Manschreck, Theo Clyde |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 8th, 2005 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700867595 | NPPES |
| Massachusetts | MEDICAID | 6190995 | |
| Massachusetts | Other | 714059 |
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