Provider Demographics
NPI:1487659421
Name:CORRENTI, PETER JR (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:CORRENTI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1503 LANSDOWNE AVE
Mailing Address - Street 2:STE 3001
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1330
Mailing Address - Country:US
Mailing Address - Phone:610-586-4100
Mailing Address - Fax:610-586-4114
Practice Address - Street 1:1503 LANSDOWNE AVE
Practice Address - Street 2:STE 3001
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1330
Practice Address - Country:US
Practice Address - Phone:610-586-4100
Practice Address - Fax:610-586-4114
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006539L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017612500004Medicaid
PA028648F7EMedicare ID - Type UnspecifiedMEDICARE
PAG50774Medicare UPIN