Provider Demographics
NPI:1548207764
Name:MORIN, PETER J (MD, PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:MORIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:ENRM VAMC BLDG 18 182 B
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-2635
Mailing Address - Fax:781-687-3832
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:ENRM VAMC BLDG 18 182 B
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-2635
Practice Address - Fax:781-687-3832
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD151352084N0400X
MA815762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology