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General NPI Number Information
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NPI Number | 1518082932
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Entity Type | Organization
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Legal Business Name | ROBERT A. THERIAULT, D.O., PLLC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 190 BROAD ST STE 103
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City | NASHUA
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State | NH
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Zip | 03063-3147
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Country | US
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Telephone | 603-578-9705
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Fax |
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Provider Business Mailing Address
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Address Line | 190 BROAD ST STE 103
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City | NASHUA
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State | NH
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Zip | 03063-3147
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Country | US
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Telephone | 603-578-9705
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROBERT THERIAULT
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Credential | D.O.
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Telephone | 603-880-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9290
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License Number State | NH
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