Provider Demographics
NPI:1962416982
Name:KASSIS, PETER B (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:B
Last Name:KASSIS
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 1:251 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-1619
Mailing Address - Country:US
Mailing Address - Phone:401-295-0960
Mailing Address - Fax:
Practice Address - Street 1:251 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:RI
Practice Address - Zip Code:02822-0282
Practice Address - Country:US
Practice Address - Phone:401-295-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME21217207QA0401X
MA223636207QA0401X
NH17768207QA0401X
VT0420014083207QA0401X
CT55708207QA0401X
RI17086207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110040753/AMedicaid
MA110040753/AMedicaid
MAA38749Medicare PIN