Provider Demographics
NPI:1922024033
Name:JENKIN, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:JENKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:789-371-7010
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:87 MCGREGOR ST STE 2100
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3767
Practice Address - Country:US
Practice Address - Phone:603-626-7546
Practice Address - Fax:603-626-7548
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25285207N00000X
WAMD00037526207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039576OtherLABOR & INDUSTRY
WA3312JEOtherBLUE SHIELD
WAUS7199048OtherAETNA/USHC SPECIALIST
WA8249948Medicaid
070016647OtherRAILROAD MEDICARE
WAAB35064Medicare PIN
WA8249948Medicaid