Provider Demographics
NPI:1407959505
Name:SCARPELLI, PETER (PA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SCARPELLI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-0010
Mailing Address - Country:US
Mailing Address - Phone:518-773-5758
Mailing Address - Fax:518-773-5456
Practice Address - Street 1:2862 ROUTE 8
Practice Address - Street 2:
Practice Address - City:SPECULATOR
Practice Address - State:NY
Practice Address - Zip Code:12164-0000
Practice Address - Country:US
Practice Address - Phone:518-548-8155
Practice Address - Fax:518-548-4819
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003453-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS53116Medicare UPIN