Healthcare Provider Details

I. General information

NPI: 1578750808
Provider Name (Legal Business Name): PETER STANTON DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 WESTBROOK RD
ESSEX CT
06426-1511
US

IV. Provider business mailing address

192 WESTBROOK RD
ESSEX CT
06426-1511
US

V. Phone/Fax

Practice location:
  • Phone: 860-767-1200
  • Fax: 860-767-3031
Mailing address:
  • Phone: 860-767-1200
  • Fax: 860-767-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33140
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: