Provider Demographics
NPI:1598806804
Name:PETER DEWIRE, M.D., P.C.
Entity Type:Organization
Organization Name:PETER DEWIRE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-376-2017
Mailing Address - Street 1:54 MILLER ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4725
Mailing Address - Country:US
Mailing Address - Phone:617-376-2017
Mailing Address - Fax:
Practice Address - Street 1:54 MILLER ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4725
Practice Address - Country:US
Practice Address - Phone:617-376-2017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9751980Medicaid
MAE67264Medicare UPIN
MA9751980Medicaid
5757790001Medicare NSC