Provider Demographics
NPI:1134309990
Name:LITCHFIELD, PETER MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:LITCHFIELD
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:PO BOX 23736
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-3736
Mailing Address - Country:US
Mailing Address - Phone:423-426-4188
Mailing Address - Fax:
Practice Address - Street 1:189 ANDREW ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6296
Practice Address - Country:US
Practice Address - Phone:423-569-3762
Practice Address - Fax:423-569-4909
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065367207P00000X
AL30027208D00000X
NC2013-00015208D00000X
TN45503208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134309990Medicaid
TN1516619Medicaid
VA1134309990Medicaid