Provider Demographics
NPI:1841300845
Name:OSTROW, PETER ADAM (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ADAM
Last Name:OSTROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 PARK AVE UNIT 303
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-4105
Mailing Address - Country:US
Mailing Address - Phone:617-763-2800
Mailing Address - Fax:
Practice Address - Street 1:TUFTS MEDICAL CENTER
Practice Address - Street 2:800 WASHINGTON STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-0211
Practice Address - Country:US
Practice Address - Phone:781-455-6200
Practice Address - Fax:781-449-1096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA49412207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJO2134Medicare UPIN