Provider Demographics
NPI:1942794656
Name:CHRISTOPHER H. PETEROS, DPM, LLC
Entity Type:Organization
Organization Name:CHRISTOPHER H. PETEROS, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:HARTLEY
Authorized Official - Last Name:PETEROS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-567-6860
Mailing Address - Street 1:1200 CONVERSE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1760
Mailing Address - Country:US
Mailing Address - Phone:413-567-6860
Mailing Address - Fax:413-567-1491
Practice Address - Street 1:1200 CONVERSE ST STE 103
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1760
Practice Address - Country:US
Practice Address - Phone:413-567-6860
Practice Address - Fax:413-567-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1972213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty