Provider Demographics
NPI:1154412674
Name:AUERBACH, PETER T (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:T
Last Name:AUERBACH
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 1:491 GOLD STAR HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6226
Mailing Address - Country:US
Mailing Address - Phone:860-445-5107
Mailing Address - Fax:860-448-1368
Practice Address - Street 1:491 GOLD STAR HWY
Practice Address - Street 2:STE 100
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-445-5107
Practice Address - Fax:860-448-1368
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26245207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001262450Medicaid
E67607Medicare UPIN
CT001262450Medicaid