Provider Demographics
NPI:1679649073
Name:HACKER, PETER SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SAM
Last Name:HACKER
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2919
Practice Address - Country:US
Practice Address - Phone:603-577-5315
Practice Address - Fax:603-577-5316
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201609Medicaid
404402OtherTUFTS
NH0104689YPNH01OtherBCBS
E66693Medicare UPIN
NHNH9579Medicare PIN