Basic Information
| Provider Information | |||||||||
| NPI: | 1649251406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINER | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 01/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 222813 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0033439 | 01 | MA | NEIGHBORHOOD HLTH PLAN | OTHER | 042297845 | 01 | MA | HCVM | OTHER | 042297845 | 01 | MA | TRICARE | OTHER | 7190585 | 01 | MA | AETNA | OTHER | 042297845 | 01 | MA | DOC FIRST | OTHER | 2090350 | 05 | MA | MEDICAID | 91256 | 01 | MA | FALLON | OTHER | AA18464 | 01 | MA | HVD PILGRIM HEALTH CARE | OTHER | J28098 | 01 | MA | BCBS | OTHER | 6690812 | 01 | MA | CIGNA | OTHER | 042297845 | 01 | MA | GIC UNICARE | OTHER | 042297845 | 01 | MA | GREAT WEST HEALTH CARE | OTHER | 469907 | 01 | MA | TUFTS | OTHER | 042297845 | 01 | MA | PRIVATE HEALTHCARE SYSTEM | OTHER | 042297845 | 01 | MA | UNITED HEALTH CARE | OTHER |