Provider Demographics
NPI:1629232889
Name:D'ANGONA, PETER BRIAN (MD; MPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BRIAN
Last Name:D'ANGONA
Suffix:
Gender:M
Credentials:MD; MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WAREHAM ST UNIT 507
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2750
Mailing Address - Country:US
Mailing Address - Phone:323-697-4823
Mailing Address - Fax:
Practice Address - Street 1:90 WAREHAM ST
Practice Address - Street 2:UNIT 507
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:323-697-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56646207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ0586503Medicare PIN