Provider Demographics
NPI:1699314153
Name:DBA JOHN R PETEET MD
Entity type:Organization
Organization Name:DBA JOHN R PETEET MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETEET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-278-0438
Mailing Address - Street 1:1 BROOKLINE PLACE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7277
Mailing Address - Country:US
Mailing Address - Phone:617-278-0438
Mailing Address - Fax:617-632-8136
Practice Address - Street 1:1 BROOKLINE PLACE
Practice Address - Street 2:SUITE 502
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7277
Practice Address - Country:US
Practice Address - Phone:617-278-0438
Practice Address - Fax:617-632-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty