Provider Demographics
NPI:1023358777
Name:PEMA, PETER JAMES JR (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:PEMA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4581 LANGPORT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4265
Mailing Address - Country:US
Mailing Address - Phone:614-451-4235
Mailing Address - Fax:
Practice Address - Street 1:4581 LANGPORT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-4265
Practice Address - Country:US
Practice Address - Phone:614-451-4235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-001151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121200Medicaid