Provider Demographics
NPI:1649251406
Name:MINER, TERI LOU (DO)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:LOU
Last Name:MINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0033439OtherNEIGHBORHOOD HLTH PLAN
MA042297845OtherHCVM
MA042297845OtherTRICARE
MA7190585OtherAETNA
MA042297845OtherDOC FIRST
MA2090350Medicaid
MA91256OtherFALLON
MAAA18464OtherHVD PILGRIM HEALTH CARE
MAJ28098OtherBCBS
MA6690812OtherCIGNA
MA042297845OtherGIC UNICARE
MA042297845OtherGREAT WEST HEALTH CARE
MA469907OtherTUFTS
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MA042297845OtherUNITED HEALTH CARE
MA6690812OtherCIGNA
MAAA18464OtherHVD PILGRIM HEALTH CARE