Provider Demographics
NPI:1902870322
Name:WEITZMAN, PETER A (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:WEITZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 RUSSELL ST
Mailing Address - Street 2:HADLEY FAMILY PRACTICE
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-3534
Mailing Address - Country:US
Mailing Address - Phone:413-586-6020
Mailing Address - Fax:413-584-0286
Practice Address - Street 1:234 RUSSELL ST
Practice Address - Street 2:#7, HADLEY FAMILY PRACTICE
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-3534
Practice Address - Country:US
Practice Address - Phone:413-586-6020
Practice Address - Fax:413-584-0286
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3194547OtherCONSOLIDATED
MA04-3194547OtherGREAT-WEST
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
MA04-3194547OtherPRIVATE HEALTHCARE SYSTEM
MA10241040OtherCIGNA
MA7923OtherBMC
MAJ07722OtherBCBSMA
MA71792OtherHARVARD PILGRIM
MA04-3194547OtherNORTH AMERICAN PREFERRED
MA20410OtherHEALTH NEW ENGLAND
MA04-3194547OtherNORTHEAST HEALTH DIRECT
MA04-3194547OtherUNICARE/GIC
MA060247OtherTUFTS
MA3039081Medicaid
MA04-3194547OtherPLAN VISTA
MA2358527OtherAETNA
J07722Medicare ID - Type Unspecified
MA7923OtherBMC