Provider Demographics
NPI:1881688224
Name:ZUCKER, PETER K (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:ZUCKER
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 1:1 ESSEX CENTER DR
Mailing Address - Street 2:LAHEY CLINIC INC
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2901
Mailing Address - Country:US
Mailing Address - Phone:781-744-8000
Mailing Address - Fax:781-744-1099
Practice Address - Street 1:1 ESSEX CENTER DR
Practice Address - Street 2:LAHEY CLINIC INC
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:781-744-8000
Practice Address - Fax:781-744-1099
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31087207VX0201X
MA45662207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD157381100Medicaid
MD157381100Medicaid
MD9904Medicare PIN
MD157381100Medicaid