Healthcare Provider Details

I. General information

NPI: 1699314153
Provider Name (Legal Business Name): DBA JOHN R PETEET MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PLACE SUITE 502
BROOKLINE MA
02445-7277
US

IV. Provider business mailing address

1 BROOKLINE PLACE SUITE 502
BROOKLINE MA
02445-7277
US

V. Phone/Fax

Practice location:
  • Phone: 617-278-0438
  • Fax: 617-632-8136
Mailing address:
  • Phone: 617-278-0438
  • Fax: 617-632-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN R PETEET
Title or Position: PROVIDER
Credential: M.D.
Phone: 617-278-0438