Provider Demographics
NPI:1255342796
Name:HERMIDA, TERESA ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ELIZABETH
Last Name:HERMIDA
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 1:736 OLD LEWISTON RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-4121
Mailing Address - Country:US
Mailing Address - Phone:207-377-8122
Mailing Address - Fax:207-377-8564
Practice Address - Street 1:736 OLD LEWISTON RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-4121
Practice Address - Country:US
Practice Address - Phone:207-377-8122
Practice Address - Fax:207-377-8564
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0161472084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0234Medicare ID - Type Unspecified
H58418Medicare UPIN