Provider Demographics
NPI:1942240940
Name:FLOTTE, TERENCE R (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:R
Last Name:FLOTTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TERENCE
Other - Middle Name:ROBIN
Other - Last Name:FLOTTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-441-8086
Practice Address - Fax:774-441-8071
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2339952080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110077445AMedicaid
MA000420901OtherMEDICARE
MA000420901OtherMEDICARE
MA000420901Medicare PIN