1568087393 NPI number — MARIA TERESA PERALTA ESPEJO MD

Table of content: MARIA TERESA PERALTA ESPEJO MD (NPI 1568087393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568087393 NPI number — MARIA TERESA PERALTA ESPEJO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERALTA ESPEJO
Provider First Name:
MARIA TERESA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568087393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/18/2022
NPI Reactivation Date:
02/22/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
282 WASHINGTON ST
Provider Second Line Business Mailing Address:
STE 4H
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-545-9986
Provider Business Mailing Address Fax Number:
860-545-9159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEDIATRIC RESIDENCY PROGRAM
Provider Second Line Business Practice Location Address:
282 WASHINGTON STREET
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-545-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)