Provider Demographics
NPI:1528031135
Name:PETERSON, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:PETERSON
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 1:25 BUTTRICK RD
Mailing Address - Street 2:BLDG. E
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3352
Mailing Address - Country:US
Mailing Address - Phone:603-437-1003
Mailing Address - Fax:603-421-0868
Practice Address - Street 1:25 BUTTRICK RD
Practice Address - Street 2:BLDG. E
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3352
Practice Address - Country:US
Practice Address - Phone:603-437-1003
Practice Address - Fax:603-421-0868
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9844208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010353Medicaid
G45169Medicare UPIN
PERE4422Medicare ID - Type Unspecified