Provider Demographics
NPI:1447214283
Name:WARINNER, PETER Q (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:Q
Last Name:WARINNER
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 1:200 BROADWAY STE 203
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2349
Mailing Address - Country:US
Mailing Address - Phone:781-237-0070
Mailing Address - Fax:781-237-0090
Practice Address - Street 1:200 BROADWAY STE 203
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-2349
Practice Address - Country:US
Practice Address - Phone:781-237-0070
Practice Address - Fax:781-237-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2080602084N0400X, 2084N0600X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH92579Medicare UPIN