Healthcare Provider Details

I. General information

NPI: 1821076688
Provider Name (Legal Business Name): THEODOR THOMAS HERWIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INDEPENDENCE WAY
BREWSTER MA
02631
US

IV. Provider business mailing address

1 INDEPENDENCE WAY
BREWSTER MA
02631
US

V. Phone/Fax

Practice location:
  • Phone: 508-896-0050
  • Fax: 508-896-0012
Mailing address:
  • Phone: 508-896-0050
  • Fax: 508-896-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number72413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: