Provider Demographics
NPI:1821184144
Name:BRIGHAM, PETER MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MAURICE
Last Name:BRIGHAM
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 1:12 ALFRED ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1972
Mailing Address - Country:US
Mailing Address - Phone:781-646-0500
Mailing Address - Fax:617-646-6432
Practice Address - Street 1:22 MILL ST
Practice Address - Street 2:SUITE 308
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4784
Practice Address - Country:US
Practice Address - Phone:781-646-0500
Practice Address - Fax:617-646-6432
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA496722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6183948Medicaid
MAJ03591Medicare ID - Type UnspecifiedNHIC
MA6183948Medicaid
MAJ03591Medicare UPIN
MAA00764Medicare UPIN