Provider Demographics
NPI:1750346177
Name:DAVIDSON, PETER K (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2052
Mailing Address - Country:US
Mailing Address - Phone:413-582-2555
Mailing Address - Fax:
Practice Address - Street 1:38 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-5338
Practice Address - Country:US
Practice Address - Phone:413-727-3882
Practice Address - Fax:413-727-8691
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164400-1207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3183505Medicaid
MA3183505Medicaid
MAC66006Medicare UPIN