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General NPI Number Information
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NPI Number | 1194868596
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Entity Type | Individual
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Provider Name | MYRON B PETERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CATO LTD. 1100 WINTER STREET
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City | WALTHAM
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State | MA
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Zip | 02451
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Country | US
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Telephone | 617-484-2297
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Fax |
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Provider Business Mailing Address
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Address Line | 71 OAK STREET
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City | BELMONT
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State | MA
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Zip | 02478
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Country | US
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Telephone | 617-484-2297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 41235
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License Number State | MA
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