Healthcare Provider Details

I. General information

NPI: 1770594525
Provider Name (Legal Business Name): NERHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PRESCOTT ST
WORCESTER MA
01605-2610
US

IV. Provider business mailing address

85 PRESCOTT ST
WORCESTER MA
01605-2610
US

V. Phone/Fax

Practice location:
  • Phone: 508-890-5633
  • Fax: 508-890-1125
Mailing address:
  • Phone: 508-890-5633
  • Fax: 508-890-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number51010
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9711449
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
IdentifierM17898
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS

VIII. Authorized Official

Name: HERBERT G MARKLEY
Title or Position: DIRECTOR
Credential: M.D.
Phone: 508-890-5633