Healthcare Provider Details

I. General information

NPI: 1457393506
Provider Name (Legal Business Name): GEORGE F VITEK MD & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 BOSTON ROAD
WILBRAHAM MA
01095-1155
US

IV. Provider business mailing address

2207 BOSTON ROAD
WILBRAHAM MA
01095-1155
US

V. Phone/Fax

Practice location:
  • Phone: 413-599-1201
  • Fax: 413-596-2940
Mailing address:
  • Phone: 413-599-1201
  • Fax: 413-596-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier92810
Identifier TypeOTHER
Identifier State
Identifier IssuerFALLON HEALTH PLAN
# 2
Identifier969334
Identifier TypeOTHER
Identifier State
Identifier IssuerNETWORK HEALTH
# 3
IdentifierM16903
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS
# 4
Identifier608730
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS
# 5
Identifier608730
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS HEALTH PLAN
# 6
Identifier000000008137
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHNET
# 7
Identifier6638
Identifier TypeOTHER
Identifier State
Identifier IssuerAET USHC
# 8
Identifier8404
Identifier TypeOTHER
Identifier State
Identifier IssuerCONNECTICARE
# 9
Identifier9784098
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DR. KIMBERLY J MARTINS
Title or Position: PRESIDENT
Credential: MD
Phone: 413-599-1201