Provider Demographics
NPI:1396743209
Name:PIL, PIETER M (MD)
Entity type:Individual
Prefix:
First Name:PIETER
Middle Name:M
Last Name:PIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-1406
Mailing Address - Country:US
Mailing Address - Phone:508-684-4500
Mailing Address - Fax:508-684-4502
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557-1406
Practice Address - Country:US
Practice Address - Phone:508-684-4500
Practice Address - Fax:508-684-4502
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA213619208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0174271Medicaid
H66561Medicare UPIN
MAH34375Medicare ID - Type Unspecified