Individual
DR. PETER C ENTWISTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
54 PUDDING BROOK DR, PEMBROKE, MA 02359-2008
(781) 826-7197
Mailing address
50 MATTAKEESETT ST, PEMBROKE, MA 02359-2531
(781) 293-3427
(781) 826-7198
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
4237
MA
103T00000X
Psychologist
4237
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WO4515
BLUE CROSS-BLUE SHIELD
MA
Enumeration date
07/31/2007
Last updated
07/31/2007
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