Provider Demographics
NPI:1740497031
Name:STAIGER, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:STAIGER
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 1:369 NEW BRITAIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1351
Mailing Address - Country:US
Mailing Address - Phone:860-828-1900
Mailing Address - Fax:860-828-6390
Practice Address - Street 1:369 NEW BRITAIN RD STE C
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-1351
Practice Address - Country:US
Practice Address - Phone:860-828-1900
Practice Address - Fax:860-828-6390
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039711207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008031636Medicaid
CT400037650Medicare PIN
CTH40578Medicare UPIN