Provider Demographics
NPI:1467524405
Name:TIERNEY, PETER CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHRISTOPHER
Last Name:TIERNEY
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 1:666 PLAINSBORO RD
Mailing Address - Street 2:SUITE 1316
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3030
Mailing Address - Country:US
Mailing Address - Phone:609-275-8100
Mailing Address - Fax:609-275-6133
Practice Address - Street 1:666 PLAINSBORO RD
Practice Address - Street 2:SUITE 1316
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3030
Practice Address - Country:US
Practice Address - Phone:609-275-8100
Practice Address - Fax:609-275-6133
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04463200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3861007Medicaid
NJTI199040Medicare ID - Type Unspecified
NJ3861007Medicaid