Provider Demographics
NPI:1194707158
Name:PETERSON, JAMES E (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:19 DEPOT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1856
Mailing Address - Country:US
Mailing Address - Phone:413-743-1080
Mailing Address - Fax:413-743-5306
Practice Address - Street 1:19 DEPOT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1856
Practice Address - Country:US
Practice Address - Phone:413-743-1080
Practice Address - Fax:413-743-5306
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA42739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2041111Medicaid
MA2041111Medicaid
MAB77030Medicare UPIN