Provider Demographics
NPI:1134302334
Name:DAVIS, PETER ARNOLD (PA-C)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ARNOLD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 EASTERN POINT RD
Mailing Address - Street 2:BLDG 97, YARD HOSPITAL
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4905
Mailing Address - Country:US
Mailing Address - Phone:860-433-2070
Mailing Address - Fax:860-433-7802
Practice Address - Street 1:75 EASTERN POINT RD
Practice Address - Street 2:BLDG 97, YARD HOSPITAL
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4905
Practice Address - Country:US
Practice Address - Phone:860-433-2070
Practice Address - Fax:860-433-7802
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000200363A00000X
RIPA00318363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant