Provider Demographics
NPI:1457313009
Name:PETROS, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:PETROS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:170 MORTON ST
Mailing Address - Street 2:DOB 503
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3735
Mailing Address - Country:US
Mailing Address - Phone:617-971-3568
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVENUE
Practice Address - Street 2:MOAKLEY SUITE 2100
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-8054
Practice Address - Fax:617-414-8055
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-02-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA48543208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110053342AMedicaid
MA110053342AMedicaid