Healthcare Provider Details

I. General information

NPI: 1588598999
Provider Name (Legal Business Name): THIERRY MICHAEL NORDMANN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANIFORD ST
BOSTON MA
02114-2517
US

IV. Provider business mailing address

50 STANIFORD ST
BOSTON MA
02114-2517
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5001567
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: