Provider Demographics
NPI:1699719500
Name:PETERS, GREGORY ALAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:PETERS
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 1:87 SPRING ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3156
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-524-0089
Practice Address - Street 1:87 SPRING ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3156
Practice Address - Country:US
Practice Address - Phone:603-524-3211
Practice Address - Fax:603-524-0089
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH92262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0109698Y0NH01OtherANTHEM
NH111190OtherCIGNA
NH30006844Medicaid
NHRE3163Medicare ID - Type Unspecified
NH30006844Medicaid