Healthcare Provider Details

I. General information

NPI: 1972546562
Provider Name (Legal Business Name): PETER R MCKNIGHT RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAPLE ST NORWALK HOSPITAL
NORWALK CT
06850-3815
US

IV. Provider business mailing address

59 ROBIN LN
FAIRFIELD CT
06824-3939
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2906
  • Fax:
Mailing address:
  • Phone: 203-330-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000116
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: