Provider Demographics
NPI:1730148149
Name:SIERSMA, PETER W (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:SIERSMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14 WILLIAMS ST
Mailing Address - Street 2:PO BOX 765
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01096-9427
Mailing Address - Country:US
Mailing Address - Phone:413-268-3616
Mailing Address - Fax:413-268-0337
Practice Address - Street 1:14 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MA
Practice Address - Zip Code:01096-9427
Practice Address - Country:US
Practice Address - Phone:413-268-3616
Practice Address - Fax:413-268-0337
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA79023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
MA717459OtherTUFTS
MA000000008323OtherBMC
MA04-3194547OtherCONSOLIDATED
MA04-3194547OtherPLAN VISTA
MA04-3194547OtherUNICARE/GIC
MA16424OtherHNE
MA528959OtherAETNA
MA04-3194547OtherNORTH AMERICAN PREFERRED
MA04-3194547OtherUNITED HEALTHCARE
MA515970OtherHEALTHSOURCE
MAJ05149OtherBCBSMA
MA04-3194547OtherGREAT-WEST
MA3005763Medicaid
MA04-3194547OtherNORTHEAST HEALTH DIRECT
MA04-3194547OtherPHCS
MA6337318007OtherCIGNA
MA731026OtherCONNECTICARE
MA04-3194547OtherNORTHEAST HEALTHCARE ALLI
J05149Medicare ID - Type Unspecified