Provider Demographics
NPI:1457393506
Name:GEORGE F VITEK MD & ASSOCIATES PC
Entity Type:Organization
Organization Name:GEORGE F VITEK MD & ASSOCIATES PC
Other - Org Name:PEDIATRIC & ADOLESCENT MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-599-1201
Mailing Address - Street 1:2207 BOSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1155
Mailing Address - Country:US
Mailing Address - Phone:413-599-1201
Mailing Address - Fax:413-596-2940
Practice Address - Street 1:2207 BOSTON ROAD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1155
Practice Address - Country:US
Practice Address - Phone:413-599-1201
Practice Address - Fax:413-596-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
92810OtherFALLON HEALTH PLAN
969334OtherNETWORK HEALTH
M16903OtherBCBS
608730OtherTUFTS
608730OtherTUFTS HEALTH PLAN
000000008137OtherHEALTHNET
6638OtherAET USHC
8404OtherCONNECTICARE
MA9784098Medicaid