Provider Demographics
NPI:1285609479
Name:MIETKIEWICZ, LESTER P (MD)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:P
Last Name:MIETKIEWICZ
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:
Practice Address - Street 1:367 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2323
Practice Address - Country:US
Practice Address - Phone:508-334-1448
Practice Address - Fax:508-334-1443
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherONE HEALTH PLAN
4034906OtherAETNA US HEALTHCARE
8239846OtherCIGNA HEALTH PLAN
J02901OtherBLUE SHIELD INDEMNITY
0400875OtherEVERCARE
28035OtherHEALTHY START
9900029OtherFALLON COMMUNITY HEALTH
AA1293OtherHARVARD PILGRIM HEALTHCAR
J02901OtherBLUE CARE ELECT
28035OtherCHILDRENS MEDICAL
043058466OtherHEALTHCARE VALUE MANAGEME
J02901OtherBLUE SHIELD HMO BLUE
784252OtherMVP HEALTH CARE
934972OtherFIRST HEALTH
042472266OtherTHREE RIVERS
042472266OtherPRIVATE HEALTHCARE
MA6180493Medicaid
MAJ02901Medicare ID - Type Unspecified
28035OtherHEALTHY START
J02901Medicare ID - Type UnspecifiedB
MAJ0290101Medicare PIN