Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CR1035 | ME |
NPI | 1376549428 |
---|---|
Provider Name | Margaret I Peterson |
First Address | Belfast, ME 04915 |
Second Address | Belfast, ME 04915-6630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037085 | BLUE CROSS BLUE SHIELD (01) | ME |
M23713 | TRICARE (01) | ME |
U74575 | (02) | ME |