MEDICARE: DR. PETER D OLDAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	34334	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164404851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER D OLDAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 62
Second Line	:	TURNPIKE STATION
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-0062
Country	:	US
Telephone Number	:	508-334-8815
Fax Number	:	508-334-5374

Provider Business Practice Location Address
First Line	:	201 HIGHLAND ST
Second Line	:	DEPARTMENT OF EMERGENCY MEDICINE
City	:	CLINTON
State	:	MA
Zip	:	01510-1037
Country	:	US
Telephone Number	:	978-368-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	07/08/2007

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