Provider Demographics
NPI:1790776730
Name:TERLATO, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:TERLATO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 GREEN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1396
Mailing Address - Country:US
Mailing Address - Phone:978-630-5020
Mailing Address - Fax:978-630-5029
Practice Address - Street 1:250 GREEN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1396
Practice Address - Country:US
Practice Address - Phone:978-630-5020
Practice Address - Fax:978-630-5029
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-04-22
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Provider Licenses
StateLicense IDTaxonomies
MA73621207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3079830Medicaid
MAJ1145801Medicare UPIN
MA3079830Medicaid