Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 38924 | MA |
NPI | 1003873027 |
---|---|
Provider Name | Peter Whittredge |
First Address | Springfield, MA 01107-1270 |
Second Address | Springfield, MA 01107-1270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 13/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2072394 | (05) | MA |
A66908 | (02) | MA |