Provider Demographics
NPI:1427231620
Name:PETER L. KING D.P.M.
Entity Type:Organization
Organization Name:PETER L. KING D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-623-1599
Mailing Address - Street 1:2245 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1101
Mailing Address - Country:US
Mailing Address - Phone:610-623-1599
Mailing Address - Fax:610-623-9066
Practice Address - Street 1:2245 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1101
Practice Address - Country:US
Practice Address - Phone:610-623-1599
Practice Address - Fax:610-623-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002869L332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010971100001Medicaid
PA0060355000OtherKEYSTONE HEALTH PLAN EAST
PA003563Medicare PIN
PAT27023Medicare UPIN
PA0921260001Medicare NSC
PA0921260002Medicare NSC