Provider Demographics
NPI:1588630628
Name:PETERS, EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:PETERS
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 1:4 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3314
Mailing Address - Country:US
Mailing Address - Phone:207-861-5000
Mailing Address - Fax:207-861-5001
Practice Address - Street 1:4 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3314
Practice Address - Country:US
Practice Address - Phone:207-861-5000
Practice Address - Fax:207-861-5001
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109320099Medicaid
MED03831Medicare UPIN
ME106992Medicare ID - Type Unspecified