Provider Demographics
NPI:1770601809
Name:ROBERT L. VAN UITERT, M.D., P.C.
Entity type:Organization
Organization Name:ROBERT L. VAN UITERT, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEGRANDE
Authorized Official - Last Name:VAN UITERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-664-6321
Mailing Address - Street 1:77 HOSPITAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2550
Mailing Address - Country:US
Mailing Address - Phone:413-664-6321
Mailing Address - Fax:413-663-9208
Practice Address - Street 1:77 HOSPITAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2550
Practice Address - Country:US
Practice Address - Phone:413-664-6321
Practice Address - Fax:413-663-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA455702084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0140554Medicaid
MAA55691Medicare UPIN
MAM31668Medicare ID - Type Unspecified