Provider Demographics
NPI:1922032564
Name:PETERS, MAURICE ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:ROBERT
Last Name:PETERS
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 1:170 EAST 77TH STREET
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1912
Mailing Address - Country:US
Mailing Address - Phone:212-369-9200
Mailing Address - Fax:212-369-5048
Practice Address - Street 1:170 EAST 77TH STREET
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1912
Practice Address - Country:US
Practice Address - Phone:212-369-9200
Practice Address - Fax:212-369-5048
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23003112085R0202X
CT0440422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026716600001Medicaid
MD4599021 01Medicaid
PA1026716600001Medicaid
NYA400035708Medicare PIN
MD4599021 01Medicaid
NYA400050815Medicare PIN