Provider Demographics
NPI:1568087393
Name:PERALTA ESPEJO, MARIA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:PERALTA ESPEJO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 WASHINGTON ST
Mailing Address - Street 2:STE 4H
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106
Mailing Address - Country:US
Mailing Address - Phone:860-545-9986
Mailing Address - Fax:860-545-9159
Practice Address - Street 1:PEDIATRIC RESIDENCY PROGRAM
Practice Address - Street 2:282 WASHINGTON STREET
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2022-02-22
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program