Provider Demographics
NPI:1669449534
Name:BOTCHAN, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:BOTCHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:66 CONCORD ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2179
Mailing Address - Country:US
Mailing Address - Phone:978-694-8999
Mailing Address - Fax:978-658-8957
Practice Address - Street 1:66 CONCORD ST
Practice Address - Street 2:SUITE L
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2179
Practice Address - Country:US
Practice Address - Phone:978-694-8999
Practice Address - Fax:978-658-8957
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-01-05
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Provider Licenses
StateLicense IDTaxonomies
MA74761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110050480AMedicaid
MA9770585Medicaid
E78659Medicare UPIN
MA9770585Medicaid