Provider Demographics
NPI:1427178508
Name:RAIA, PETER JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:RAIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 JOBS LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4862
Mailing Address - Country:US
Mailing Address - Phone:631-283-9526
Mailing Address - Fax:631-283-6491
Practice Address - Street 1:89 JOBS LANE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4862
Practice Address - Country:US
Practice Address - Phone:631-283-9526
Practice Address - Fax:631-283-6491
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY177072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E74449Medicare UPIN
NY03F441Medicare ID - Type Unspecified