Provider Demographics
NPI:1922449024
Name:PETERS, MARINA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:SELIVERSTOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-419-3408
Mailing Address - Fax:617-534-2611
Practice Address - Street 1:774 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2520
Practice Address - Country:US
Practice Address - Phone:617-534-4681
Practice Address - Fax:857-288-2253
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2649522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry