Provider Demographics
NPI:1316181308
Name:MIKHAIL, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MIKHAIL
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 1:199 OAK ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1953
Mailing Address - Country:US
Mailing Address - Phone:781-829-7000
Mailing Address - Fax:877-991-5373
Practice Address - Street 1:199 OAK ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1953
Practice Address - Country:US
Practice Address - Phone:781-829-7000
Practice Address - Fax:877-991-5373
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0985342084P0800X
PAMD4445942084P0800X
DCMD0404762084P0800X
MDD00740782084P0800X
CT530972084P0800X
NY2662262084P0800X
MI43011018422084P0800X
VA01012661602084P0800X
MA2777462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16083178Medicare PIN