Provider Demographics
NPI:1811976384
Name:CHRISTAKOS, PETER G (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:CHRISTAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2052
Mailing Address - Country:US
Mailing Address - Phone:413-582-2175
Mailing Address - Fax:413-582-2954
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2175
Practice Address - Fax:413-582-2954
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223215207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6301423OtherCIGNA
MAAA25150OtherHARVARD PILGRIM
MA011303OtherTUFTS
MAJ24564OtherBCBS MA
MA2092361Medicaid
MA35391OtherHEALTH NEW ENGLAND
MA000000029147OtherBMC
MA011303OtherTUFTS
MAJ24564OtherBCBS MA