Individual
MICHAEL EDMOND THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21 INDUSTRIAL BLVD, PAOLI, PA 19301-1610
(610) 647-8000
Mailing address
21 INDUSTRIAL BLVD, PAOLI, PA 19301-1610
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD473446
PA
Other
Enumeration date
04/11/2016
Last updated
11/03/2021
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