Provider Demographics
NPI:1467426080
Name:THEERMAN, MICHAEL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:THEERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:201 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1640
Mailing Address - Country:US
Mailing Address - Phone:508-755-7830
Mailing Address - Fax:508-754-2987
Practice Address - Street 1:46 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1653
Practice Address - Country:US
Practice Address - Phone:508-835-3934
Practice Address - Fax:508-835-3934
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA38111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE21017OtherBLUE CROSS
MA23518OtherCIGNA
MA64765OtherHARVARD-PILGRIM HEALTHCAR
MA4977OtherFALLON HEALTH PLAN
MA0180629Medicaid
MA712458OtherTUFTS
MA0180629Medicaid
MAE21017OtherBLUE CROSS