Healthcare Provider Details

I. General information

NPI: 1538158522
Provider Name (Legal Business Name): JAMES M PETERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MAIN ST SUITE 210
NASHUA NH
03060-2919
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-2759
  • Fax: 603-577-3081
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16287
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: