Provider Demographics
NPI:1275691982
Name:GIAMMANCO, PETER P (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:GIAMMANCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-884-7620
Mailing Address - Fax:215-884-7896
Practice Address - Street 1:8380 OLD YORK RD STE 100
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1574
Practice Address - Country:US
Practice Address - Phone:215-517-5000
Practice Address - Fax:215-517-5829
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003475L207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0047023OtherAETNA HMO
PA0047254000OtherINDEPENDENCE BLUE CROSS
PAP00416091OtherRR MEDICARE
PA483429OtherCOVENTRY HEALTH AMERICA
PA1702OtherBRAVO HEALTH
PA1162861OtherCIGNA
PA126654OtherHIGHMARK BLUE SHIELD
PA597586OtherMEDICARE GROUP
PA000756102Medicaid
PA30037433OtherKEYSTONE MERCY
PA4676005OtherAETNA PPO
PACD4829OtherRR MEDICARE GROUP
PA4676005OtherAETNA PPO
PA000756102Medicaid