Active NPI
Peter C Entwistle, PH.D.
- Clinical Neuropsychologist
- Pembroke, MA
National Provider Identifier
1477743854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 4237
- Practice address
- 54 Pudding Brook Dr
Pembroke, MA 02359-2008 - Phone
- (781) 826-7197
- NPI assigned
- Jul 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 4237 | MA | Primary |
| Psychologist | 103T00000X | 4237 | MA |
Addresses
Primary practice location
54 Pudding Brook Dr
Pembroke, MA 02359-2008
Mailing address
50 Mattakeesett St
Pembroke, MA 02359-2531
Phone (781) 293-3427
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| WO4515 | Other | MA | BLUE CROSS-BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4237 | MA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185840000000",
"number": "1477743854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 MATTAKEESETT ST",
"city": "PEMBROKE",
"state": "MA",
"postal_code": "023592531",
"telephone_number": "781-293-3427",
"fax_number": "781-826-7198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54 PUDDING BROOK DR",
"city": "PEMBROKE",
"state": "MA",
"postal_code": "023592008",
"telephone_number": "781-826-7197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENTWISTLE",
"first_name": "PETER",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-31",
"last_updated": "2007-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MA",
"license": "4237",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "4237",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS-BLUE SHIELD",
"identifier": "WO4515",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pembroke, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.