Provider Demographics
NPI:1285657023
Name:DEFELICE, PEGGY (MD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:DEFELICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 BETHLEHEM PIKE
Mailing Address - Street 2:A106
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031
Mailing Address - Country:US
Mailing Address - Phone:215-836-1700
Mailing Address - Fax:215-836-2705
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:A106
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031
Practice Address - Country:US
Practice Address - Phone:215-836-1700
Practice Address - Fax:215-836-2705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-035573-E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE64191Medicare UPIN
PA519222Medicare ID - Type Unspecified