Provider Demographics
NPI:1457576001
Name:HATTEMER, THERESE IDA (MD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:IDA
Last Name:HATTEMER
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 1:108 CHURCHILL AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7822
Mailing Address - Country:US
Mailing Address - Phone:781-488-3303
Mailing Address - Fax:
Practice Address - Street 1:108 CHURCHILL AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-7822
Practice Address - Country:US
Practice Address - Phone:781-488-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA567692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08558OtherBLUE CROSS BLUE SHIELD
MA56769OtherMEDICAL LICENSE
MAE10081Medicare ID - Type Unspecified