Provider Demographics
NPI:1336151604
Name:PETERS, GEORGE B III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:B
Last Name:PETERS
Suffix:III
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 1:700 MOUNT HOPE AVE 470
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5660
Mailing Address - Country:US
Mailing Address - Phone:207-945-4474
Mailing Address - Fax:207-941-5913
Practice Address - Street 1:281 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2138
Practice Address - Country:US
Practice Address - Phone:508-334-6855
Practice Address - Fax:508-334-6795
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2652207W00000X, 207WX0107X, 207WX0108X
FLME137023207W00000X
ME015982207WX0107X, 207WX0108X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008854Medicaid
NY2095687Medicaid
NY2095687Medicaid
NYDD5468Medicare PIN