Provider Demographics
NPI:1104895556
Name:MUTTER, WALTER PETER (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:PETER
Last Name:MUTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEWTON WELLESLEY HOSPITAL, GREEN 460
Mailing Address - Street 2:NEWTON WELLESLEY PHYSICIANS NEPHROLOGY
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:20462
Mailing Address - Country:US
Mailing Address - Phone:617-243-5420
Mailing Address - Fax:
Practice Address - Street 1:NEWTON WELLESLEY PHYSICIANS NEPHROLOGY
Practice Address - Street 2:NEWTON WELLESLEY HOSPITAL, GREEN 460
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:20462
Practice Address - Country:US
Practice Address - Phone:617-243-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210130207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24722OtherBLUE CROSS BLUE SHEILD
MA5594198OtherFIRST HEALTH
MA693019OtherHARVARD PILGRIM HEALTHCAR
MA0167100Medicaid
MA210130OtherTUFTS HEALTH PLAN
MAH56631Medicare UPIN
MDMUA33649Medicare ID - Type Unspecified