Provider Demographics
NPI:1568026433
Name:PACUT, PETER PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:PAUL
Last Name:PACUT
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 1:55 LAKE AVENUE NORTH
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655
Mailing Address - Country:US
Mailing Address - Phone:774-442-2173
Mailing Address - Fax:774-442-6781
Practice Address - Street 1:55 LAKE AVENUE NORTH
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655
Practice Address - Country:US
Practice Address - Phone:774-442-2173
Practice Address - Fax:774-442-6781
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2020-01-17
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-01-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program