Provider Demographics
NPI:1316591647
Name:LERZA, PETER ANTHONY II
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:LERZA
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 BYRN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1911
Mailing Address - Country:US
Mailing Address - Phone:302-629-6611
Mailing Address - Fax:
Practice Address - Street 1:801 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3636
Practice Address - Country:US
Practice Address - Phone:302-629-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC003632363L00000X
DELG-00001294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner