Provider Demographics
NPI:1235163361
Name:MCKAY, PETER S (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:MCKAY
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 1:1375 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5318
Mailing Address - Country:US
Mailing Address - Phone:203-366-8000
Mailing Address - Fax:
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-886-0161
Practice Address - Fax:860-889-5999
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037313207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0804960OtherUNITED HEALTHCARE
7294127002OtherCIGNA
CT010037313CT01OtherBCS
CT0V7359OtherHEALTHNET
190317OtherPREFERRED ONE
2353634OtherAETNA
P2135757OtherOXFORD
CT001373133Medicaid
741852OtherCONNECTICARE
7294127002OtherCIGNA
190317OtherPREFERRED ONE
CT001373133Medicaid