Provider Demographics
NPI:1881680775
Name:ALTHERR, DORIS L (MD)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:L
Last Name:ALTHERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-2828
Mailing Address - Country:US
Mailing Address - Phone:860-585-3906
Mailing Address - Fax:860-585-3907
Practice Address - Street 1:7 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1957
Practice Address - Country:US
Practice Address - Phone:860-314-6886
Practice Address - Fax:860-314-6889
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001378547Medicaid
G51922Medicare UPIN
CT380000153Medicare ID - Type Unspecified