Provider Demographics
NPI:1528046968
Name:PETERS, JENNIFER B (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:275 SANDWICH ST
Mailing Address - Street 2:C/O CATHY GREY
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2183
Mailing Address - Country:US
Mailing Address - Phone:508-746-2000
Mailing Address - Fax:508-830-2502
Practice Address - Street 1:528 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8973
Practice Address - Country:US
Practice Address - Phone:802-888-8173
Practice Address - Fax:802-888-8365
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA204818207R00000X
VT0420011854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016965Medicaid
MA69997OtherHARVARD PILGRIM
MA0100862Medicaid
MA409393OtherTUFTS HEALTH PLAN
MAJ22421OtherBCBSMA
VT001298901Medicare PIN
MA409393OtherTUFTS HEALTH PLAN
MA69997OtherHARVARD PILGRIM