Provider Demographics
NPI:1639160336
Name:HARPOLD, THERESA LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LYNNE
Last Name:HARPOLD
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:4065 E HILLS CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6299
Mailing Address - Country:US
Mailing Address - Phone:616-942-2081
Mailing Address - Fax:
Practice Address - Street 1:6900 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1168
Practice Address - Country:US
Practice Address - Phone:586-501-3070
Practice Address - Fax:248-386-5176
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2050232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H53450Medicare UPIN