Provider Demographics
NPI:1356462410
Name:TRICIA VORDERSTRASSE MD PC
Entity Type:Organization
Organization Name:TRICIA VORDERSTRASSE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VORDERSTRASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-249-1791
Mailing Address - Street 1:250 GREEN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1396
Mailing Address - Country:US
Mailing Address - Phone:978-249-1791
Mailing Address - Fax:978-249-1794
Practice Address - Street 1:250 GREEN ST
Practice Address - Street 2:SUITE 1 06
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1396
Practice Address - Country:US
Practice Address - Phone:978-249-1791
Practice Address - Fax:978-249-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty