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General NPI Number Information
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NPI Number | 1477821296
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Entity Type | Organization
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Legal Business Name | PETER A. SMALL, M.D., PC
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 2119 POST RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-5657
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Country | US
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Telephone | 203-259-7400
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Fax | 203-259-1115
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Provider Business Mailing Address
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Address Line | 2119 POST RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-5657
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Country | US
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Telephone | 203-259-7400
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Fax | 203-259-1115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER ALAN SMALL
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Credential | M.D.
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Telephone | 203-259-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 028063
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License Number State | CT
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