Provider Demographics
NPI:1225629371
Name:PETER J MIOTTO
Entity Type:Organization
Organization Name:PETER J MIOTTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MIOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-229-3640
Mailing Address - Street 1:2 GATES LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1689
Mailing Address - Country:US
Mailing Address - Phone:508-393-3950
Mailing Address - Fax:
Practice Address - Street 1:159 UNION ST STE 104
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1274
Practice Address - Country:US
Practice Address - Phone:508-229-3649
Practice Address - Fax:508-229-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty