Provider Demographics
NPI:1578956595
Name:WORCESTER INTERNAL MEDICINE
Entity Type:Organization
Organization Name:WORCESTER INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATNAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-756-1808
Mailing Address - Street 1:416 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1086
Mailing Address - Country:US
Mailing Address - Phone:508-756-1808
Mailing Address - Fax:508-798-0538
Practice Address - Street 1:416 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1086
Practice Address - Country:US
Practice Address - Phone:508-756-1808
Practice Address - Fax:508-798-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264759363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty