Provider Demographics
NPI:1427035351
Name:PETEROS, CHRISTOPHER H (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:H
Last Name:PETEROS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CONVERSE ST
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1760
Mailing Address - Country:US
Mailing Address - Phone:413-567-6860
Mailing Address - Fax:413-567-1491
Practice Address - Street 1:1200 CONVERSE ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1760
Practice Address - Country:US
Practice Address - Phone:413-567-6860
Practice Address - Fax:413-567-1491
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1972213ES0103X, 213E00000X
CT000578213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70950Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER
MA0559660001Medicare NSC
MAU30221Medicare UPIN