Provider Demographics
NPI:1508062472
Name:FELDMAN, PETER STEVEN (DPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:STEVEN
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEDFORD ST STE 17
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4440
Mailing Address - Country:US
Mailing Address - Phone:781-863-5320
Mailing Address - Fax:781-863-2743
Practice Address - Street 1:35 BEDFORD ST STE 17
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4440
Practice Address - Country:US
Practice Address - Phone:781-863-5320
Practice Address - Fax:781-863-2743
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1012103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01099OtherBLUE CROSS BLUE SHIELD
MAW01099Medicare ID - Type Unspecified