Provider Demographics
NPI:1235163783
Name:LEVESQUE, PETER E (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:LEVESQUE
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 1:72 WASHINGTON ST
Mailing Address - Street 2:SUITE 2220
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2491
Mailing Address - Country:US
Mailing Address - Phone:508-823-5104
Mailing Address - Fax:508-880-7870
Practice Address - Street 1:72 WASHINGTON ST
Practice Address - Street 2:SUITE 2220
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2491
Practice Address - Country:US
Practice Address - Phone:508-823-5104
Practice Address - Fax:508-880-7870
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA75540208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3152359Medicaid
G26327Medicare UPIN
MAA21235Medicare PIN