Provider Demographics
NPI:1700861655
Name:WAITE, MARTHA BORGES (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:BORGES
Last Name:WAITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:FRANCES
Other - Last Name:BORGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-885-2003
Mailing Address - Fax:508-885-8071
Practice Address - Street 1:64 BOYDEN RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520
Practice Address - Country:US
Practice Address - Phone:508-885-2003
Practice Address - Fax:508-885-8071
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73863208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
27044OtherCHILDRENS MEDICAL SECURIT
4532668OtherAETNA US HEALTHCARE
991088OtherFALLON COMMUNITY HEALTH
J30184OtherBLUE CARE SELECT
J30184OtherBLUE SHIELD HMO BLUE
042472266OtherTHREE RIVERS
1061488OtherFIRST HEALTH
3548144OtherCIGNA HEALTHSOURCE
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
784208OtherMVP HEALTH CARE
AA1183OtherHARVARD PILGRIM
27044OtherHEALTHY START
MA110053797AMedicaid
J30184OtherBLUE SHIELD INDEMNITY
MA3118169Medicaid
0424472266OtherHEALTHCARE VALUE
27044OtherCHILDRENS MEDICAL SECURIT
27044OtherHEALTHY START