Healthcare Provider Details

I. General information

NPI: 1821104241
Provider Name (Legal Business Name): PAUL S PEICOTT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ESSEX CENTER DR SUITE 208
PEABODY MA
01960-2910
US

IV. Provider business mailing address

81 HIGHLAND AVE NORTH SHORE HEALTH SYSTEMS
SALEM MA
01970
US

V. Phone/Fax

Practice location:
  • Phone: 978-531-9969
  • Fax: 978-531-3745
Mailing address:
  • Phone: 978-354-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1746
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: