Provider Demographics
NPI:1215356050
Name:PETER M DEVITO MD INC
Entity Type:Organization
Organization Name:PETER M DEVITO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE VITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-3985
Mailing Address - Street 1:7600 SOUTHERN BLVD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6085
Mailing Address - Country:US
Mailing Address - Phone:330-758-3985
Mailing Address - Fax:
Practice Address - Street 1:7600 SOUTHERN BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6085
Practice Address - Country:US
Practice Address - Phone:330-758-3985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259376Medicaid
OH0259376Medicaid
0804001Medicare PIN