Healthcare Provider Details

I. General information

NPI: 1669689543
Provider Name (Legal Business Name): SUZANNE WEISS DBA WORCESTER PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST SUITE 690
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST SUITE 690
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-9530
  • Fax: 508-363-9535
Mailing address:
  • Phone: 508-363-9530
  • Fax: 508-363-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUZANNE M WEISS
Title or Position: OWNER
Credential: M.D.
Phone: 508-363-9530