Provider Demographics
NPI:1801943816
Name:BACKMAN, JOHN HERBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HERBERT
Last Name:BACKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1681
Mailing Address - Country:US
Mailing Address - Phone:508-368-3533
Mailing Address - Fax:508-363-1502
Practice Address - Street 1:305 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1681
Practice Address - Country:US
Practice Address - Phone:508-368-3533
Practice Address - Fax:508-363-1502
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276752084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry