Provider Demographics
NPI:1558562215
Name:THEODOR T. HERWIG, M.D., P.C.
Entity Type:Organization
Organization Name:THEODOR T. HERWIG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODOR
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HERWIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-896-0050
Mailing Address - Street 1:1 INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1906
Mailing Address - Country:US
Mailing Address - Phone:508-896-0050
Mailing Address - Fax:508-896-0012
Practice Address - Street 1:1 INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1906
Practice Address - Country:US
Practice Address - Phone:508-896-0050
Practice Address - Fax:508-896-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9713531Medicaid
MA718001OtherTUFTS
MA7783OtherHARVARD PILGRIM
MAM17926OtherBCBS GROUP NUMBER
MAB10032101OtherCIGNA
MA01-00760OtherUNITED HEALTH CARE
MA718001OtherTUFTS
MAD92803Medicare UPIN