Provider Demographics
NPI:1366482556
Name:MILSTEIN, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MILSTEIN
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 1:196 PARKWAY SOUTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-443-4383
Mailing Address - Fax:860-437-0819
Practice Address - Street 1:196 PARKWAY SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-443-4383
Practice Address - Fax:860-443-3980
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT21580207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
500HBC444CT01OtherANTHEM:HOSP-BASED ECCD
P2523177OtherOXFORD/ECCD: 06-1616101
060014260OtherRR MED/ECCG: 06-1049086
CT001215805Medicaid
010021580CT01OtherANTHEM/ECCG: 06-1049086
060064819OtherRR MED/ECCD: 06-1616101
001215805OtherBLUECARE FAMILY PLAN
010021580CT05OtherANTHEM/ECCD: 06-1616101
030251OtherHEALTHNET/ECCG:06-1049086
0V9735OtherHEALTHNET/ECCD:06-1616101
769086OtherCONNECTICARE
NLS106OtherOXFORD/ECCG: 06-1049086
010021580CT05OtherANTHEM/ECCD: 06-1616101
P2523177OtherOXFORD/ECCD: 06-1616101
060001429Medicare ID - Type UnspecifiedECCD: 06-1616101