Healthcare Provider Details

I. General information

NPI: 1619375474
Provider Name (Legal Business Name): NORMAN DAVID PETERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WINSOR RD
N SCITUATE RI
02857-1172
US

IV. Provider business mailing address

30 WINSOR RD
N SCITUATE RI
02857-1172
US

V. Phone/Fax

Practice location:
  • Phone: 401-934-1832
  • Fax:
Mailing address:
  • Phone: 401-934-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberRI5272
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: