Healthcare Provider Details

I. General information

NPI: 1083670764
Provider Name (Legal Business Name): MIGUEL AZEVEDO PEIXOTO NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COURTHOUSE LN SUITE 9
CHELMSFORD MA
01824-1728
US

IV. Provider business mailing address

4 COURTHOUSE LN SUITE 9
CHELMSFORD MA
01824-1728
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-8400
  • Fax:
Mailing address:
  • Phone: 978-459-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number259834
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: