Provider Demographics
NPI:1578750808
Name:DIXON, PETER STANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:STANTON
Last Name:DIXON
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 1:192 WESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1511
Mailing Address - Country:US
Mailing Address - Phone:860-767-1200
Mailing Address - Fax:860-767-3031
Practice Address - Street 1:192 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1511
Practice Address - Country:US
Practice Address - Phone:860-767-1200
Practice Address - Fax:860-767-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT33140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0V1563OtherOXFORD
050463OtherCONNECTICARE
001292448001OtherUNITED HEALTHCARE
CT001331404Medicaid
CT010033140CT03OtherANTHEM BCBS
0614533610001OtherCIGNA
1417970708OtherNPI
4407476OtherAETNA
0V1563OtherOXFORD
CTC90513Medicare UPIN