Healthcare Provider Details

I. General information

NPI: 1437120094
Provider Name (Legal Business Name): VICTORIA PAMELA PETERS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COMPUTER DR STE 301
WESTBOROUGH MA
01581-1790
US

IV. Provider business mailing address

780 CHESTNUT ST STE 23
SPRINGFIELD MA
01107-1610
US

V. Phone/Fax

Practice location:
  • Phone: 617-420-5316
  • Fax:
Mailing address:
  • Phone: 413-787-2800
  • Fax: 413-787-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number76807
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number76807
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: