Provider Demographics
NPI:1235762741
Name:MANTELL, PETER DOUGLAS III
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DOUGLAS
Last Name:MANTELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MILLERS FALLS RD
Mailing Address - Street 2:
Mailing Address - City:TURNERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01376-2250
Mailing Address - Country:US
Mailing Address - Phone:413-835-1564
Mailing Address - Fax:
Practice Address - Street 1:130 MILLERS FALLS RD
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-2250
Practice Address - Country:US
Practice Address - Phone:413-835-1564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA175T00000XOtherCLINICAL AND SUPPORT OPTIONS