Provider Demographics
NPI:1144259011
Name:PYATAK, PETER STEVEN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:STEVEN
Last Name:PYATAK
Suffix:
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 1:1071 CARE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8431
Mailing Address - Country:US
Mailing Address - Phone:540-374-3100
Mailing Address - Fax:540-374-3102
Practice Address - Street 1:1071 CARE WAY STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-374-3100
Practice Address - Fax:540-374-3102
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055569207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010237718Medicaid
VA187974OtherANTHEM BCBS OF VA
VA27993OtherSENTARA
VA332378OtherSOUTHERN HEALTH SERVICES
VA010237696Medicaid
VA1164229OtherAETNA HMO
VA382013OtherMAMSI
VA0929005OtherCIGNA
VA187976OtherANTHEM BCBS OF VA
VA4369562OtherAETNA LIFE
VA187974OtherANTHEM BCBS OF VA
VA27993OtherSENTARA