Provider Demographics
NPI:1669689543
Name:SUZANNE WEISS DBA WORCESTER PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:SUZANNE WEISS DBA WORCESTER PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-363-9530
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 690
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-9530
Mailing Address - Fax:508-363-9535
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 690
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-9530
Practice Address - Fax:508-363-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8674OtherFALLON
MA9786597Medicaid
MAM15694OtherBLUE CROSS
MA600568OtherTUFTS
MA99840701OtherNETWORK HEALTH
MA9300OtherAETNA