Provider Demographics
NPI:1578564340
Name:FAY, PETER MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MARTIN
Last Name:FAY
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 1:174 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2420
Mailing Address - Country:US
Mailing Address - Phone:508-226-1809
Mailing Address - Fax:508-226-4228
Practice Address - Street 1:174 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2420
Practice Address - Country:US
Practice Address - Phone:508-226-1809
Practice Address - Fax:508-226-4228
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160731207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9738932Medicaid
A31058Medicare ID - Type Unspecified
MA9738932Medicaid