Provider Demographics
NPI:1366489072
Name:KLICH-NOWAK, TERESA I (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:I
Last Name:KLICH-NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22 ATWOOD DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4267
Mailing Address - Country:US
Mailing Address - Phone:413-584-9511
Mailing Address - Fax:413-584-4218
Practice Address - Street 1:22 ATWOOD DR
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4267
Practice Address - Country:US
Practice Address - Phone:413-584-9511
Practice Address - Fax:413-584-4218
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA209407207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7829624OtherAETNA
MA31530OtherHEALTH NEW ENGLAND
MAJ24433OtherBLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS
MA110004866AMedicaid
MA209407OtherTUFTS
MAAA523851OtherHARVARD HEALTH PLAN
MA209407OtherCONNECTICARE
MA524481OtherFALLON
MA7829624OtherAETNA