Provider Demographics
NPI:1750343299
Name:ELLER, PETER M (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:ELLER
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 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:720-434-4876
Mailing Address - Fax:303-225-4246
Practice Address - Street 1:5920 MCINTYRE ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-7445
Practice Address - Country:US
Practice Address - Phone:720-434-4876
Practice Address - Fax:303-225-4246
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059376207R00000X
RIMD6148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2588OtherNEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
406221OtherTUFTS
RI7002228Medicaid
04-00335OtherUNITEDHEALTHCARE
RI200318OtherBLUE CHIP OF RHODE ISLAND
RI29736-9OtherBLUE SHIELD OF RHODE ISLAND
C90723Medicare UPIN
RI7002228Medicaid