Healthcare Provider Details

I. General information

NPI: 1922055706
Provider Name (Legal Business Name): MARIE H HOBART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

IV. Provider business mailing address

72 JAQUES AVE.
WORCESTER MA
01610
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1025
  • Fax: 508-860-1068
Mailing address:
  • Phone: 508-860-1025
  • Fax: 508-860-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number56874
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: