Provider Demographics
NPI:1114026614
Name:THOMASHOW, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:THOMASHOW
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 547
Mailing Address - Street 2:ATT: FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-4316
Mailing Address - Fax:802-371-4579
Practice Address - Street 1:130 FISHER RD
Practice Address - Street 2:CENTRAL VERMONT MEDICAL CENTER
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-371-4316
Practice Address - Fax:802-371-4579
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00100462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN229701OtherMEDICARE PTAN LINKED TO CVMC
VTOVN2297Medicaid
A64784Medicare UPIN
VTVN229701OtherMEDICARE PTAN LINKED TO CVMC