Provider Demographics
NPI:1114107430
Name:DEMARIA, PETER A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:DEMARIA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N. BROAD ST. 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121
Mailing Address - Country:US
Mailing Address - Phone:215-204-7276
Mailing Address - Fax:215-204-5419
Practice Address - Street 1:1700 N. BROAD ST. 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121
Practice Address - Country:US
Practice Address - Phone:215-204-7276
Practice Address - Fax:215-204-5419
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-034505-E2084P0802X
PAMD034505-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFO1897OtherUPIN