Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 001597 | CT |
Y | 111NN0400X | Neurology | 1497 | MA |
NPI | 1164564902 |
---|---|
Provider Name | Dr. Peter Paul Percuoco |
First Address | Hudson, MA 01749-2108 |
Second Address | Hudson, MA 01749-2108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 04/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T95574 | (02) | MA |
Y36030 | BLUE CROSS BLUE SHIELD MA (01) | MA |