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NPI Code Detail

MEDICARE: DR. SUSAN PELTZ M.D.

MEDICARE: DR. SUSAN PELTZ M.D.
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
12085R0202XDiagnostic Radiology Physician53252MA

General Provider Information

NPI Number : 1760450530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN PELTZ M.D.
Provider Business Mailing Address
First Line : 38 MORNINGSIDE LN
Second Line :
City : LINCOLN
State : MA
Zip : 01773-2704
Country : US
Telephone Number : 781-259-0573
Fax Number :
Provider Business Practice Location Address
First Line : 135 GOLD STAR BLVD
Second Line :
City : WORCESTER
State : MA
Zip : 01606-2738
Country : US
Telephone Number : 508-425-6003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 01/04/2012

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