Provider Demographics
NPI:1063484467
Name:GERIATRIC MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GERIATRIC MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:PAMELA
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:413-787-2800
Mailing Address - Street 1:780 CHESTNUT ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1616
Mailing Address - Country:US
Mailing Address - Phone:413-787-2800
Mailing Address - Fax:413-787-2822
Practice Address - Street 1:780 CHESTNUT ST
Practice Address - Street 2:SUITE 23
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1616
Practice Address - Country:US
Practice Address - Phone:413-787-2800
Practice Address - Fax:413-787-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
66697OtherHARVARD PILGRIM
M17556OtherBCBS OF MA
3370368OtherAETNA HEALTH
724714J173OtherCONNECTICARE
P00078010OtherRAILROAD MEDICARE
M21439OtherMEDICARE
691352OtherTURFS SECURE HORIZONS
DA9195OtherRAILROAD MEDICARE
000000023021OtherHEALTHNET
MAM21439Medicare ID - Type Unspecified
000000023021OtherHEALTHNET