Healthcare Provider Details

I. General information

NPI: 1922068576
Provider Name (Legal Business Name): LAURA LYNNE PETERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN STREET
WORCESTER MA
01610-2473
US

IV. Provider business mailing address

10 CENTRAL ST
SOUTHBOROUGH MA
01772-1626
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-7700
  • Fax: 508-661-3046
Mailing address:
  • Phone: 508-229-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number73351
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: