Provider Demographics
NPI:1528042553
Name:DOURDOUFIS, PETER J (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:DOURDOUFIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BORTHWICK AVENUE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-433-5300
Mailing Address - Fax:603-433-0838
Practice Address - Street 1:333 BORTHWICK AVENUE
Practice Address - Street 2:SUITE 401
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-5300
Practice Address - Fax:603-433-0838
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10327207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011604Medicaid
0403796YONH01OtherANTHEM
61411OtherCIGNA
NHBX8301Medicare PIN
0403796YONH01OtherANTHEM