Provider Demographics
NPI:1295771970
Name:DAVIDOW, PETER C (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:DAVIDOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:328 SHREWSBURY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4613
Mailing Address - Country:US
Mailing Address - Phone:508-755-4861
Mailing Address - Fax:508-752-1392
Practice Address - Street 1:328 SHREWSBURY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4613
Practice Address - Country:US
Practice Address - Phone:508-755-4861
Practice Address - Fax:508-752-1392
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA59428207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0011217OtherNEIGHBORHOOD HEALTH
MAJ09429OtherBCBS
059428OtherTUFTS
130014OtherHARVARD PILGRIM
24872OtherFALLON
MA3058557Medicaid
98863803OtherNETWORK HEALTH
MA3058557Medicaid
059428OtherTUFTS