Provider Demographics
NPI:1548257090
Name:FORD, PETER A (APRN)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:FORD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-246-2071
Mailing Address - Fax:860-524-2650
Practice Address - Street 1:11 SOUTH RD STE 130
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2483
Practice Address - Country:US
Practice Address - Phone:860-224-5433
Practice Address - Fax:860-224-5933
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001918363L00000X, 363LA2200X
CT1918367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1548257090Medicaid
CT191800OtherCONNECTICARE
CT400001918CT05OtherANTHEM BCBS
CT06-1406459OtherTRICARE
CT400001918CT05OtherANTHEM BCBS
CT191800OtherCONNECTICARE
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEM
CT1548257090Medicaid
CT3V0156OtherHEALTH NET
CT500002200Medicare PIN