Provider Demographics
NPI:1760023592
Name:ARMATA, PETER PETRUCCI
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:PETRUCCI
Last Name:ARMATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BEACON ST
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1928
Mailing Address - Country:US
Mailing Address - Phone:617-726-9700
Mailing Address - Fax:
Practice Address - Street 1:100 N BEACON ST
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1928
Practice Address - Country:US
Practice Address - Phone:617-726-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2293198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner