# ROBERT A. THERIAULT, D.O., PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518082932
- **Authorized official:** ROBERT THERIAULT D.O. (PHYSICIAN)
- **Authorized official phone:** (603) 880-1511

## Contact information

- **Practice address:** 190 BROAD ST STE 103, NASHUA, NH 03063-3147
- **Practice address phone:** (603) 578-9705
- **Mailing address:** 190 BROAD ST STE 103, NASHUA, NH 03063-3147
- **Mailing address phone:** (603) 578-9705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 9290 | NH | Yes |

## Other

- **Enumeration date:** 03/21/2007
- **Last updated:** 04/22/2016