Provider Demographics
NPI:1063473312
Name:CIMINO, PETER R (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:CIMINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 POST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6038
Mailing Address - Country:US
Mailing Address - Phone:203-255-8827
Mailing Address - Fax:203-259-4610
Practice Address - Street 1:1300 POST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6038
Practice Address - Country:US
Practice Address - Phone:203-255-8827
Practice Address - Fax:203-259-4610
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT037114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG76921Medicare UPIN