Provider Demographics
NPI:1932690757
Name:HERTENSTEIN PEREZ, AUDREY LELA (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LELA
Last Name:HERTENSTEIN PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:LELA
Other - Last Name:HERTENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 QUEEN ST STE 13
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2478
Mailing Address - Country:US
Mailing Address - Phone:508-860-7962
Mailing Address - Fax:508-860-7929
Practice Address - Street 1:26 QUEEN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7800
Practice Address - Fax:508-796-7025
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA287720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine