Provider Demographics
NPI:1972598811
Name:DOUBILET, PETER MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:DOUBILET
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-6251
Mailing Address - Fax:617-525-7333
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6251
Practice Address - Fax:617-525-7333
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA486102085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0153192Medicaid
MA048610OtherTUFTS HEALTH CARE
MAA66286BWHTOtherHARVARD PILGRIM HEALTH CA
MAE05793OtherBLUE CROSS/BLUE SHIELD
MAE05793OtherBLUE CROSS/BLUE SHIELD
MAE05793Medicare ID - Type Unspecified