Provider Demographics
NPI:1164758702
Name:PETER DITORO MD PC
Entity Type:Organization
Organization Name:PETER DITORO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DITORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-7358
Mailing Address - Street 1:600 SAINT CLAIR AVE SW
Mailing Address - Street 2:BLDG 5 SUITE 10
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5008
Mailing Address - Country:US
Mailing Address - Phone:256-536-7358
Mailing Address - Fax:256-539-4083
Practice Address - Street 1:600 SAINT CLAIR AVE SW
Practice Address - Street 2:BLDG 5 SUITE 10
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5008
Practice Address - Country:US
Practice Address - Phone:256-536-7358
Practice Address - Fax:256-539-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-01
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4003527OtherAETNA
AL000001752Medicaid
AL01752Medicare UPIN