Provider Demographics
NPI:1578596169
Name:PAICOS, PETER C JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:PAICOS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:BYFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01922-1601
Mailing Address - Country:US
Mailing Address - Phone:781-760-4096
Mailing Address - Fax:
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:S-411
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1702
Practice Address - Country:US
Practice Address - Phone:781-979-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1860213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0371824001OtherPAL
MA33199OtherHARVARD PILGRIM
MA720289OtherTUFTS GROUP
MAB20539501OtherCIGNA
MAY70874OtherBCBSMA
MAY77137OtherBCBSMA GROUP
MA67220OtherHEALTH SOURCE
MA2704470OtherHCVM
MA710674OtherTUFTS INDIVIDUAL
MA87831OtherAETNA
MAB20539501OtherCIGNA
MA67220OtherHEALTH SOURCE
MAT58801Medicare UPIN
MA710674OtherTUFTS INDIVIDUAL