Individual
THEO E MEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, DEPARTMENT OF CARDIOVASCULAR MEDICINE, WORCESTER, MA 01655-0002
(508) 334-3452
(774) 441-7657
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
150067
MA
207RC0000X
Cardiovascular Disease Physician
Primary
150067
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110054155A
—
MA
05
—
3121895
—
MA
Enumeration date
11/28/2005
Last updated
11/12/2020
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