Provider Demographics
NPI:1548213481
Name:DUFFY, PETER LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:LOUIS
Last Name:DUFFY
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:PO BOX 843232
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3232
Mailing Address - Country:US
Mailing Address - Phone:910-715-8600
Mailing Address - Fax:910-715-8613
Practice Address - Street 1:7 REGIONAL CIR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9796
Practice Address - Country:US
Practice Address - Phone:910-715-8600
Practice Address - Fax:910-715-8613
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501230207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC007682OtherDOCTORS HEALTH PLAN
NC68957OtherMEDCOST
NCFH1000110OtherFIRST CAROLINA CARE
NC060040795OtherRAILROAD
NC29270OtherBLUE CROSS BLUE SHIELD
SCN01230OtherSC MEDICAID
NC8929270Medicaid
NC8929270Medicaid
NC2229838Medicare ID - Type UnspecifiedMEDICARE