Provider Demographics
NPI:1952397549
Name:PETER, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:PETER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:88 NORWICH NEW LONDON TPKE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2518
Mailing Address - Country:US
Mailing Address - Phone:860-367-0087
Mailing Address - Fax:860-367-0117
Practice Address - Street 1:88 NORWICH NEW LONDON TPKE
Practice Address - Street 2:SUITE #2
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2518
Practice Address - Country:US
Practice Address - Phone:860-367-0087
Practice Address - Fax:860-367-0117
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT39485207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1394858Medicaid
CT1394858Medicaid