Basic Information
Provider Information | |||||||||
NPI: | 1255593828 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PEERAN | ||||||||
FirstName: | SYED | ||||||||
MiddleName: | MOHIUDDIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 200 GRIFFIN RD STE 6 | ||||||||
Address2: |   | ||||||||
City: | PORTSMOUTH | ||||||||
State: | NH | ||||||||
PostalCode: | 038017145 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036104430 | ||||||||
FaxNumber: | 6036104432 | ||||||||
Practice Location | |||||||||
Address1: | 3 TERRASCAPE PKWY | ||||||||
Address2: |   | ||||||||
City: | SOMERSWORTH | ||||||||
State: | NH | ||||||||
PostalCode: | 038781115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6038426060 | ||||||||
FaxNumber: | 6036926040 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2008 | ||||||||
LastUpdateDate: | 01/04/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/06/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 17784 | NH | Y |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
ID | Type | State | Issuer | Description | 3106122 | 05 | NH |   | MEDICAID |