Provider Demographics
NPI:1003873027
Name:WHITTREDGE, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:WHITTREDGE
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 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:413-781-5735
Mailing Address - Fax:413-732-0225
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 410
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-781-5735
Practice Address - Fax:413-732-0225
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38924207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2072394Medicaid
MAM09343Medicare PIN
MAM09343Medicare ID - Type Unspecified
MA2072394Medicaid