MEDICARE: PETER W. SIERSMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	79023	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04-3194547	OTHER	MA	NORTHEAST HEALTHCARE ALLI
2	717459	OTHER	MA	TUFTS
3	000000008323	OTHER	MA	BMC
4	04-3194547	OTHER	MA	CONSOLIDATED
5	04-3194547	OTHER	MA	PLAN VISTA
6	04-3194547	OTHER	MA	UNICARE/GIC
7	16424	OTHER	MA	HNE
8	528959	OTHER	MA	AETNA
9	04-3194547	OTHER	MA	NORTH AMERICAN PREFERRED
10	04-3194547	OTHER	MA	UNITED HEALTHCARE
11	515970	OTHER	MA	HEALTHSOURCE
12	J05149	OTHER	MA	BCBSMA
13	04-3194547	OTHER	MA	GREAT-WEST
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	04-3194547	OTHER	MA	NORTHEAST HEALTH DIRECT
16	04-3194547	OTHER	MA	PHCS
17	6337318007	OTHER	MA	CIGNA
18	731026	OTHER	MA	CONNECTICARE

General Provider Information

NPI Number	:	1730148149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER W. SIERSMA MD

Provider Business Mailing Address
First Line	:	14 WILLIAMS ST
Second Line	:	PO BOX 765
City	:	WILLIAMSBURG
State	:	MA
Zip	:	01096-9427
Country	:	US
Telephone Number	:	413-268-3616
Fax Number	:	413-268-0337

Provider Business Practice Location Address
First Line	:	14 WILLIAMS ST
Second Line	:
City	:	WILLIAMSBURG
State	:	MA
Zip	:	01096-9427
Country	:	US
Telephone Number	:	413-268-3616
Fax Number	:	413-268-0337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/07/2008

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Directions to “ PETER W. SIERSMA MD” Practice Location

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