Healthcare Provider Details

I. General information

NPI: 1710979463
Provider Name (Legal Business Name): PETER DAVID BYEFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MERIDEN AVE STE 1A
SOUTHINGTON CT
06489-3238
US

IV. Provider business mailing address

55 MERIDEN AVE STE 1A
SOUTHINGTON CT
06489-3238
US

V. Phone/Fax

Practice location:
  • Phone: 860-621-9316
  • Fax: 860-620-5526
Mailing address:
  • Phone: 860-621-9316
  • Fax: 860-620-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number023371
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: