Individual
SUSAN L THERRIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
240 S MAIN ST, WOLFEBORO, NH 03894-4411
(603) 569-7574
(603) 569-7582
Mailing address
240 S MAIN ST, WOLFEBORO, NH 03894-4411
(603) 569-7574
(603) 569-7582
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9132
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3084294
—
NH
01
—
RE306802
MEDICARE PTAN
—
Enumeration date
05/09/2006
Last updated
09/30/2013
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