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Individual

DR. PETER THEODORE MASIAKOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
55 FRUIT ST, WRN 11 PEDIATRIC SURGERY, BOSTON, MA 02114-2696
(617) 726-8839
(617) 726-2167
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-8839
(617) 726-2167

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
216940
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2065673
MA
01
469284
TUFTS HEALTH PLAN
MA
01
J27581
BCBS MA
MA
Enumeration date
12/06/2005
Last updated
11/30/2012
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