Basic Information
| Provider Information | |||||||||
| NPI: | 1568549285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUART | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 MEDICAL VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058559835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023344110 | ||||||||
| FaxNumber: | 8023344113 | ||||||||
| Practice Location | |||||||||
| Address1: | 81 MEDICAL VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058559835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023344110 | ||||||||
| FaxNumber: | 8023344113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0420009856 | VT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0VN2022 | 05 | VT | MEDICAID | 8000224 | 01 | VT | LADIES FIRST | OTHER | 0572880001 | 01 | VT | DME | OTHER | 160044758 | 01 | VT | RAILROAD MEDICARE | OTHER | 30203331 | 05 | NH | MEDICAID | 349689 | 01 | VT | MVP | OTHER | 00048005 | 01 | VT | BLUE SHIELD OF VERMONT | OTHER |