Provider Demographics
NPI:1659351559
Name:PETERS, ROBERT HORACE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HORACE
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 1:190 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4519
Mailing Address - Country:US
Mailing Address - Phone:203-469-0256
Mailing Address - Fax:203-469-2458
Practice Address - Street 1:190 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-4519
Practice Address - Country:US
Practice Address - Phone:203-469-0256
Practice Address - Fax:203-469-2458
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0082982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001082981Medicaid
CT260002678Medicare UPIN