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General NPI Number Information
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NPI Number | 1669689543
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Entity Type | Organization
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Legal Business Name | SUZANNE WEISS DBA WORCESTER PEDIATRIC ASSOCIATES
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 123 SUMMER ST SUITE 690
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City | WORCESTER
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State | MA
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Zip | 01608-1216
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Country | US
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Telephone | 508-363-9530
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Fax | 508-363-9535
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Provider Business Mailing Address
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Address Line | 123 SUMMER ST SUITE 690
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City | WORCESTER
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State | MA
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Zip | 01608-1216
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Country | US
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Telephone | 508-363-9530
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Fax | 508-363-9535
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUZANNE M WEISS
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Credential | M.D.
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Telephone | 508-363-9530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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