Healthcare Provider Details

I. General information

NPI: 1881688224
Provider Name (Legal Business Name): PETER K. ZUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESSEX CENTER DR LAHEY CLINIC INC
PEABODY MA
01960-2901
US

IV. Provider business mailing address

1 ESSEX CENTER DR LAHEY CLINIC INC
PEABODY MA
01960-2901
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax: 781-744-1099
Mailing address:
  • Phone: 781-744-8000
  • Fax: 781-744-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberD31087
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number45662
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: