Provider Demographics
NPI:1437120094
Name:PETERS, VICTORIA PAMELA (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:PAMELA
Last Name:PETERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CHESTNUT ST
Mailing Address - Street 2:STE 23
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1610
Mailing Address - Country:US
Mailing Address - Phone:413-787-2800
Mailing Address - Fax:413-787-2822
Practice Address - Street 1:1400 COMPUTER DR STE 301
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1790
Practice Address - Country:US
Practice Address - Phone:617-420-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76807207QG0300X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3104435OtherMASSHEALTH MEDICAID
MA0102423OtherEVERCARE
3964761OtherCIGNA HEALTHCARE
768880OtherTUFTS
768880OtherSECURE HORIZONS
18669OtherHEALTH NEW ENGLAND
P00081931OtherRAILROAD MEDICARE PIN #
MA3104435Medicaid
3404310OtherAETNA HEALTH
380001597OtherRAILROAD MEDICARE
724714OtherCONNECTICARE
DB0006OtherRAILROAD MEDICARE GRP #
J13325OtherBC BS OF MA
0032686OtherNEIGHBORHOOD HEALTH PLAN
MA0104426OtherEVERCARE
MA0104426OtherEVERCARE
3104435OtherMASSHEALTH MEDICAID
380001597OtherRAILROAD MEDICARE
3964761OtherCIGNA HEALTHCARE