Healthcare Provider Details

I. General information

NPI: 1487745329
Provider Name (Legal Business Name): PETER S HEDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CENTRAL AVENUE SUITE N
DOVER NH
03820-3434
US

IV. Provider business mailing address

750 CENTRAL AVENUE SUITE N
DOVER NH
03820-3434
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-2266
  • Fax: 603-749-3019
Mailing address:
  • Phone: 603-749-2266
  • Fax: 603-749-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number15300
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number77020
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number77020
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15300
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: