Provider Demographics
NPI:1932174620
Name:MASON, PETER A (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:MASON
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 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2694
Mailing Address - Country:US
Mailing Address - Phone:603-448-3121
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:5 ALICE PECK DAY DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2901
Practice Address - Country:US
Practice Address - Phone:603-448-3122
Practice Address - Fax:603-448-7491
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6471207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00018136OtherBLUE CROSS BLUE SHIELD VT
NH3073507Medicaid
NHC66677OtherHPHC
NHMASO085556OtherANTHEM
NH80183541Medicaid
VT1000406Medicaid
NH80183541Medicaid
VT1000406Medicaid
C66677Medicare UPIN