Provider Demographics
NPI:1669453296
Name:STEENBERGEN, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:STEENBERGEN
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 1:3 ENTERPRISE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4694
Mailing Address - Country:US
Mailing Address - Phone:203-696-6125
Mailing Address - Fax:203-696-6130
Practice Address - Street 1:3 ENTERPRISE DR STE 220
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4694
Practice Address - Country:US
Practice Address - Phone:203-696-6125
Practice Address - Fax:203-696-6130
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0253332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001253335Medicaid
E62239Medicare UPIN
CT001253335Medicaid