Basic Information
| Provider Information | |||||||||
| NPI: | 1093150260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | CLARK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 PLEASANT ST. | ||||||||
| Address2: | MEDICAL STAFF SERVICES OFFICE | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033017559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032277000 | ||||||||
| FaxNumber: | 6032283307 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032287200 | ||||||||
| FaxNumber: | 6032277562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2013 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO2872 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20988 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.