Provider Demographics
NPI:1417970708
Name:PETER S. DIXON, M.D, P.C.
Entity Type:Organization
Organization Name:PETER S. DIXON, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-767-1200
Mailing Address - Street 1:192 WESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1511
Mailing Address - Country:US
Mailing Address - Phone:860-767-1200
Mailing Address - Fax:860-767-3031
Practice Address - Street 1:192 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1511
Practice Address - Country:US
Practice Address - Phone:860-767-1200
Practice Address - Fax:860-767-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT33140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V1563OtherHEALTHNET
CT1944670005OtherCIGNA
CT050463OtherCONNECTICARE
CT830005333OtherRAILROAD MEDICARE
CT001331404Medicaid
CT010033140CT03OtherANTHEM BCBS
CTP500468OtherOXFORD
CT4407476OtherAETNA
CT050463OtherCONNECTICARE
CT1944670005OtherCIGNA