Provider Demographics
NPI:1861480162
Name:CHEUNG, PETER T (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:CHEUNG
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 1:1750 ELM STREET
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2903
Mailing Address - Country:US
Mailing Address - Phone:603-641-5800
Mailing Address - Fax:
Practice Address - Street 1:1750 ELM STREET
Practice Address - Street 2:SUITE 201C
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2903
Practice Address - Country:US
Practice Address - Phone:603-641-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7867207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHE11264OtherHARVARD PILGRIM
NH0107208Y0NH01OtherANTHEM
NH80000108Medicaid
NHRE0108Medicare ID - Type Unspecified
NHE11264OtherHARVARD PILGRIM