Provider Demographics
NPI:1669958252
Name:PELOQUIN, MARIE MARGUERITE (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:MARGUERITE
Last Name:PELOQUIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1761
Mailing Address - Country:US
Mailing Address - Phone:781-995-7042
Mailing Address - Fax:
Practice Address - Street 1:480 MAPLE ST. SUITE 201
Practice Address - Street 2:LAHEY OUTPATIENT CENTER, DANVERS
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-646-7070
Practice Address - Fax:978-750-6988
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276800207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA276800Medicaid