Healthcare Provider Details

I. General information

NPI: 1538142351
Provider Name (Legal Business Name): STEVEN MARK PETEREC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST YNHH CHILDREN'S HOSPITAL; WP-2
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST YNHH CHILDREN'S HOSPITAL; WP-2
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2320
  • Fax: 203-688-5426
Mailing address:
  • Phone: 203-688-2320
  • Fax: 203-688-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number029735
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: