Provider Demographics
NPI:1497776728
Name:POLITZER, PEDRO R (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:R
Last Name:POLITZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8051
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6575
Practice Address - Fax:617-541-7510
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-08-04
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Provider Licenses
StateLicense IDTaxonomies
MA439052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043905OtherTUFTS HEALTH PLAN
MAB11643OtherBLUE CROSS
MA0017384OtherNEIGHBORHOOD HEALTH PLAN
MAP00016768OtherMEDICARE RAILROAD
MAP00016768OtherMEDICARE RAILROAD
MAB11643Medicare PIN