Provider Demographics
NPI:1487851259
Name:PETER S. AMBRUS,M.D.,P.C.
Entity Type:Organization
Organization Name:PETER S. AMBRUS,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:AMBRUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-376-8840
Mailing Address - Street 1:1 ATHERTON LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3641
Mailing Address - Country:US
Mailing Address - Phone:617-376-8840
Mailing Address - Fax:617-376-8848
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:STE 2A
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-376-8840
Practice Address - Fax:617-376-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0148377Medicaid
MAC20260Medicare ID - Type Unspecified
MA0148377Medicaid