| Doctor Name: | THERESA D O'DOHERTY |
| NPI Number: | 1043529597 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 2258900 |
| Business Practice Address: | 20 Hope Ave Ste G 01 Waltham, MA - 024532721 |
| Business Phone Number: | 7817880005 |
| Business Fax Number: | 7817880006 |
| Mailing Address: | 20 Hope Ave, Ste G 01 WALTHAM |
| State: | MA |
| Postal Code: | 024532721 |
| Phone Number: | 7817880005 |
| Fax Number: | 7817880006 |
| NPI Enumeration Date: | 10/01/2010 |
| NPI Last Update Date: | 10/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2258900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |