Healthcare Provider Details

I. General information

NPI: 1154388528
Provider Name (Legal Business Name): PETER ANDRIJA NIGROVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE JIMMY FUND WAY RHEUMATOLOGY DIV SMITH BLDG ROOM 516C
BOSTON MA
02115
US

IV. Provider business mailing address

111 CYPRESS ST
BROOKLINE MA
02445-6002
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-1031
  • Fax: 617-525-1010
Mailing address:
  • Phone: 857-307-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number155108
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number155108
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: