Individual
CALVIN H PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
(508) 764-2448
Mailing address
PO BOX 40, SOUTHBRIDGE, MA 01550-0040
(508) 909-7799
(508) 764-2432
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C500000139
DE
363A00000X
Physician Assistant
Primary
PA1146
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000867643
—
DE
Enumeration date
01/10/2006
Last updated
12/29/2014
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