Provider Demographics
NPI:1598804387
Name:BETJEMANN, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:BETJEMANN
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 1:112 BUFFAM RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01002-9723
Mailing Address - Country:US
Mailing Address - Phone:413-582-2480
Mailing Address - Fax:
Practice Address - Street 1:COOLEY DICKINSON HOSPITAL
Practice Address - Street 2:30 LOCUST STREET
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01601
Practice Address - Country:US
Practice Address - Phone:413-582-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine