Healthcare Provider Details

I. General information

NPI: 1043292246
Provider Name (Legal Business Name): PETER WESTERVELT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAINE ST
BRUNSWICK ME
04011-3310
US

IV. Provider business mailing address

329 MAINE ST
BRUNSWICK ME
04011-3310
US

V. Phone/Fax

Practice location:
  • Phone: 207-373-2266
  • Fax: 314-454-5902
Mailing address:
  • Phone: 207-373-2266
  • Fax: 314-454-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2006008771
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number211561
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD27026
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: