Provider Demographics
NPI:1104890268
Name:GEE, PETER ELLZEY (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ELLZEY
Last Name:GEE
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 1:92 MONTVALE AVE
Mailing Address - Street 2:STONEHAM
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3647
Mailing Address - Country:US
Mailing Address - Phone:781-662-2229
Mailing Address - Fax:781-662-1811
Practice Address - Street 1:92 MONTVALE AVE
Practice Address - Street 2:STONEHAM
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3647
Practice Address - Country:US
Practice Address - Phone:781-662-2229
Practice Address - Fax:781-662-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3097749Medicaid
MAJ12832Medicare ID - Type Unspecified
MA3097749Medicaid