Physician Compare National (NPI:1073551982)

HEALTHCARE PROVIDER: ROBERT THERIAULT D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1073551982
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5799741591
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20041203000326
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	THERIAULT
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	226 BROAD ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	NASHUA
	Group Practice or individual's city
State	NH
	Group Practice or individual's state
Zip Code	030633121
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	300020
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTHERN NH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	300011
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOSEPH HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y