Provider Demographics
NPI:1609888445
Name:SHOEMAKER, THEODORE M (FAMILY PRACTICE)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:M
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:FAMILY PRACTICE
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST
Mailing Address - Street 2:MEDICAL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7700
Mailing Address - Fax:508-860-7990
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:MEDICAL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7700
Practice Address - Fax:508-860-7990
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0006767OtherNHP-GROUP
MAY10141OtherBCBS-GROUP
MAF17619OtherTRICARE/CHAMPUS
MA2227022OtherUNITED HEALTHCARE
MA0002455OtherNHP
MA347296OtherCIGNA
MA042485308OtherADVANCED BENEFIT RESOUR
MA042485308OtherNETWORK HEALTH-GROUP
MA14851OtherFALLON SELECT
MA99122301OtherNETWORK HEALTH
MA1300709Medicaid
MA23481OtherCMSP
MAY02678OtherBCBS
MA042485308OtherTRICARE/CHAMPUS-GROUP
MA70952OtherHARVARD PILGRIM
MA221804Medicare ID - Type UnspecifiedPART A-GROUP
MA1300709Medicaid
MA70952OtherHARVARD PILGRIM
MA347296OtherCIGNA
MA042485308OtherNETWORK HEALTH-GROUP