Provider Demographics
NPI:1922176734
Name:SCHUNTERMANN, PETER P (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:SCHUNTERMANN
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 1:200 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1722
Mailing Address - Country:US
Mailing Address - Phone:617-969-4877
Mailing Address - Fax:
Practice Address - Street 1:200 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1722
Practice Address - Country:US
Practice Address - Phone:617-969-4877
Practice Address - Fax:617-969-2164
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA305502084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A65981Medicare UPIN
M07906Medicare ID - Type Unspecified