Provider Demographics
NPI:1013987825
Name:TOMAIOLO, PETER P (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:TOMAIOLO
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 1:10 WINTHROP ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4435
Mailing Address - Country:US
Mailing Address - Phone:508-755-6129
Mailing Address - Fax:508-798-4826
Practice Address - Street 1:10 WINTHROP ST
Practice Address - Street 2:SUITE 311
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4435
Practice Address - Country:US
Practice Address - Phone:508-755-6129
Practice Address - Fax:508-798-4826
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2036487Medicaid
MA2036487Medicaid
MAA55099Medicare UPIN