Healthcare Provider Details

I. General information

NPI: 1215428610
Provider Name (Legal Business Name): CAITLIN PETERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6467
  • Fax: 617-243-6701
Mailing address:
  • Phone: 617-243-6467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number275687
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: