Provider Demographics
NPI:1316935380
Name:AZAR, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:AZAR
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:P.O. BOX 760
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-4260
Mailing Address - Country:US
Mailing Address - Phone:781-756-7273
Mailing Address - Fax:781-721-0725
Practice Address - Street 1:23 WARREN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4979
Practice Address - Country:US
Practice Address - Phone:781-933-1198
Practice Address - Fax:781-933-9246
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77589207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
J13734OtherBCBS
F55645Medicare UPIN
J13734OtherBCBS