Individual
MATTHEW J. PETERSILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3068
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
277195
MA
207RG0100X
Gastroenterology Physician
Primary
277195
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110116724A
—
MA
Enumeration date
03/22/2016
Last updated
01/11/2023
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