Provider Demographics
NPI:1053304717
Name:SHER, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:SHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-0284
Mailing Address - Country:US
Mailing Address - Phone:888-497-9797
Mailing Address - Fax:973-970-2386
Practice Address - Street 1:4 S MAIN ST
Practice Address - Street 2:STE 6
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-7070
Practice Address - Country:US
Practice Address - Phone:973-580-0426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTMA042.0011754207Q00000X
VT042-0011754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016964Medicaid
VT001472801Medicare PIN
G95763Medicare UPIN