Provider Demographics
NPI:1811994510
Name:FAMIGLIETTI, PETER JOHN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:FAMIGLIETTI
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 1:339 FLANDERS RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1700
Mailing Address - Country:US
Mailing Address - Phone:860-739-4811
Mailing Address - Fax:860-789-8151
Practice Address - Street 1:339 FLANDERS RD
Practice Address - Street 2:SUITE 109
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1700
Practice Address - Country:US
Practice Address - Phone:860-739-4811
Practice Address - Fax:860-739-8151
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026252207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NLS042OtherOXFORD
030671OtherHEALTH NET
4618883OtherAETNA PIN NUMBER
CT180026127OtherRAILROAD MEDICARE
346885100OtherWORKERS COMP - DEPT OF LA
CT010026252CT04OtherANTHEM BLUE CROSS
131516OtherPREFERRED ONE - FIRST CHO
AETNAOtherAETNA MANAGED CARE
262520OtherCONNECTICARE
NLS042OtherOXFORD
346885100OtherWORKERS COMP - DEPT OF LA