Provider Demographics
NPI:1588754188
Name:FUJIMURA, PEGGY H (MD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:H
Last Name:FUJIMURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DARLING LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1403
Mailing Address - Country:US
Mailing Address - Phone:808-769-2888
Mailing Address - Fax:
Practice Address - Street 1:1 MOHEGAN SUN BLVD
Practice Address - Street 2:C/O EAGLEVIEW EMPLOYEE CENTER
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1355
Practice Address - Country:US
Practice Address - Phone:860-887-2101
Practice Address - Fax:860-887-3445
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT271434-1205207Q00000X
HIMD 14438207Q00000X
CT51044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF11447Medicare UPIN