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General NPI Number Information
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NPI Number | 1558562215
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Entity Type | Organization
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Legal Business Name | THEODOR T. HERWIG, M.D., P.C.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 INDEPENDENCE WAY
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City | BREWSTER
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State | MA
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Zip | 02631-1906
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Country | US
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Telephone | 508-896-0050
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Fax | 508-896-0012
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Provider Business Mailing Address
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Address Line | 1 INDEPENDENCE WAY
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City | BREWSTER
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State | MA
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Zip | 02631-1906
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Country | US
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Telephone | 508-896-0050
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Fax | 508-896-0012
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. THEODOR THOMAS HERWIG
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Credential | M.D.
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Telephone | 508-896-0050
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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 | 72413
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License Number State | MA
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