Healthcare Provider Details

I. General information

NPI: 1306598206
Provider Name (Legal Business Name): PETERSON ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 STATE RD
DANVERS MA
01923-2567
US

IV. Provider business mailing address

4 STATE RD
DANVERS MA
01923-2567
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-3400
  • Fax: 978-774-5883
Mailing address:
  • Phone: 978-774-3400
  • Fax: 978-774-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS E PETERSON
Title or Position: OWNER/ SURGEON
Credential: D.O.
Phone: 978-774-3400