Provider Demographics
NPI:1821104241
Name:PEICOTT, PAUL S (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:PEICOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:81 HIGHLAND AVE
Mailing Address - Street 2:NORTH SHORE HEALTH SYSTEMS
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-354-4173
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 208
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-531-9969
Practice Address - Fax:978-531-3745
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1746213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0361461Medicaid
MAY70800Medicare UPIN
T58770Medicare UPIN
MA0361461Medicaid