Provider Demographics
NPI:1295725885
Name:GREENSPAN, PETER TEBET (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:TEBET
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:781-487-4340
Mailing Address - Fax:781-487-4341
Practice Address - Street 1:40 2ND AVE
Practice Address - Street 2:MASS GENERAL WEST MEDICAL GROUP STE 400
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1137
Practice Address - Country:US
Practice Address - Phone:781-487-4340
Practice Address - Fax:781-487-4341
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA44159208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB51049OtherBCBS MA
MA044159OtherTUFTS HEALTH PLAN
MA6164595Medicaid
MAB51049OtherBCBS MA
D88150Medicare UPIN