Provider Demographics
NPI:1306832290
Name:VITEK, GEORGE FRANK (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:FRANK
Last Name:VITEK
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 1:4 EDSON DR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2327
Mailing Address - Country:US
Mailing Address - Phone:413-596-8655
Mailing Address - Fax:
Practice Address - Street 1:2207 BOSTON RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1155
Practice Address - Country:US
Practice Address - Phone:413-599-1201
Practice Address - Fax:413-596-2940
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
723563OtherTUFTS
17492OtherHEALTH NEW ENGLAND
030195OtherCONNECTICARE
1240475OtherUNITED HEALTHCARE
121002OtherAETNA/USHC
51088OtherMA LICENSE
353450OtherHEALTHSOURCE MA,NH
MA6165176Medicaid
975885OtherNETWORK HEALTH
010051088MA01OtherANTHEM BCBS
100614OtherCIGNA
201092OtherHARVARD PILGRIM
28045OtherCHILDREN MEDICAL SEC PLAN
J02183OtherBCBS
J02183OtherBCBS
28045OtherCHILDREN MEDICAL SEC PLAN
51088OtherMA LICENSE