Provider Demographics
NPI:1669453601
Name:WARHAFTIG, JEREMY P (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:P
Last Name:WARHAFTIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-9147
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-681-9901
Practice Address - Street 1:75 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-9147
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-681-9901
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0024473OtherNEIGHBORHOOD HLTH PLAN
MA208026OtherTUFTS
208026OtherTUFTS MEDICARE PREFERRED
MA0118826Medicaid
MA04 2297845OtherDOC FIRST
MA7548601OtherAETNA
MA04 2297845OtherTRICARE
MAB10506001OtherCIGNA
MA04 2297845OtherPRIVATE HEALTHCARE SYSTEM
MA04 2297845OtherGIC UNICARE
MA04 2297845OtherGREAT WEST HEALTH CARE
MA04 2297845OtherHCVM
MA62139OtherFALLON
MAJ23652OtherBCBS
MA04 2297845OtherUNITED HEALTH CARE
MA204111OtherHVD PILGRIM HEALTH CARE
MA7548601OtherAETNA
MAJ23652OtherBCBS