Provider Demographics
NPI:1932190691
Name:KNUTSON, ERIC LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LLOYD
Last Name:KNUTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:
Practice Address - Street 1:370 LUNENBURG ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4541
Practice Address - Country:US
Practice Address - Phone:978-342-6018
Practice Address - Fax:978-343-4281
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47339207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4019988OtherAETNA USHEALTHCARE
MA700425OtherTUFTS
MA2099284Medicaid
MA4448OtherFALLON
MA690832OtherHARVARD PILGRIM
MAE16127OtherBLUECROSS
MA1001287OtherCIGNA
MA4019988OtherAETNA USHEALTHCARE
MA700425OtherTUFTS