Provider Demographics
NPI:1891744272
Name:DELFAUSSE, PETER BOYLSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BOYLSTON
Last Name:DELFAUSSE
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 1:224 LITTLE POND RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6204
Mailing Address - Country:US
Mailing Address - Phone:603-224-6793
Mailing Address - Fax:
Practice Address - Street 1:99 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3852
Practice Address - Country:US
Practice Address - Phone:603-271-5263
Practice Address - Fax:603-271-5209
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH41263521Medicaid
NHNH0206Medicare PIN
NHF43479Medicare UPIN