Provider Demographics
NPI:1255313383
Name:KELSEY, PETER BAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BAKER
Last Name:KELSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-6044
Mailing Address - Fax:617-724-5997
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BLK 4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-6044
Practice Address - Fax:617-724-5997
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2013-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA51447207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA051447OtherTUFTS HEALTH PLAN
MAJ03061OtherBCBS MA
MA6187846Medicaid
MA051447OtherTUFTS HEALTH PLAN
A56907Medicare UPIN