Provider Demographics
NPI:1952708968
Name:DOCTHOR P.C.
Entity Type:Organization
Organization Name:DOCTHOR P.C.
Other - Org Name:ADHD BOSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOR
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BERGERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-726-6698
Mailing Address - Street 1:75 2ND AVE.
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494
Mailing Address - Country:US
Mailing Address - Phone:781-726-6698
Mailing Address - Fax:617-326-8314
Practice Address - Street 1:75 2ND AVE.
Practice Address - Street 2:SUITE 310
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:781-726-6698
Practice Address - Fax:617-326-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204123261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health