Provider Demographics
NPI:1003902149
Name:OCAMPO, PETER TIOSECO (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:TIOSECO
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PLAZA DR
Mailing Address - Street 2:STE 9
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-6900
Mailing Address - Country:US
Mailing Address - Phone:207-883-0865
Mailing Address - Fax:207-883-0913
Practice Address - Street 1:25 PLAZA DR
Practice Address - Street 2:STE 9
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-6900
Practice Address - Country:US
Practice Address - Phone:207-883-0865
Practice Address - Fax:207-883-0913
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1031213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEU72588Medicare UPIN
MEMM8273Medicare ID - Type Unspecified