Provider Demographics
NPI:1841398252
Name:FRIEDMAN, PETER LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LAURENCE
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3129
Mailing Address - Country:US
Mailing Address - Phone:508-778-1829
Mailing Address - Fax:508-778-0113
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3129
Practice Address - Country:US
Practice Address - Phone:508-778-1829
Practice Address - Fax:508-778-0113
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42638207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA060058502OtherMEDICARE ID
11081564OtherCAQH
MA1841398252OtherUNICARE
MA25-00730OtherUNITED HEALTHCARE
MA62612OtherHARVARD PILGRIM
MA000000030996OtherBOSTON MEDICAL CENTER
MA4710577OtherCIGNA
MA1841398252OtherNETWORK HEALTH
MA778035OtherTUFTS
MA1841398252OtherGREAT WEST HEALTHCARE
MAE05241OtherBLUE CROSS BLUE SHIELD
MA0108669Medicaid
MA04-3488655OtherTRICARE
MA2272925OtherAETNA
MA778035OtherTUFTS
FRE05241Medicare ID - Type Unspecified