Provider Demographics
NPI:1508836149
Name:ROVITO, PETER F (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:F
Last Name:ROVITO
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 1:842 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4039
Mailing Address - Country:US
Mailing Address - Phone:610-437-6119
Mailing Address - Fax:610-437-4280
Practice Address - Street 1:842 N 19TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4039
Practice Address - Country:US
Practice Address - Phone:610-437-6119
Practice Address - Fax:610-437-4280
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033023E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37003Medicare UPIN
PA116119Medicare ID - Type Unspecified