Provider Demographics
NPI:1477130896
Name:PETER, MATTHEW (DPM)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PETER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 CUMMINGS CTR STE 309V
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6181
Mailing Address - Country:US
Mailing Address - Phone:978-922-0288
Mailing Address - Fax:978-927-6265
Practice Address - Street 1:900 CUMMINGS CTR STE 309V
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6181
Practice Address - Country:US
Practice Address - Phone:978-922-0288
Practice Address - Fax:978-927-6265
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2553213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery