Provider Demographics
NPI:1538140900
Name:MOTEL, PETER J (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:MOTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1260 VALLEY FORGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2691
Mailing Address - Country:US
Mailing Address - Phone:610-983-3980
Mailing Address - Fax:610-983-3406
Practice Address - Street 1:1260 VALLEY FORGE RD
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2691
Practice Address - Country:US
Practice Address - Phone:610-983-3980
Practice Address - Fax:610-983-3406
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037752E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070011011OtherRAIL ROAD MEDICARE
F63826Medicare UPIN
PA098274Medicare ID - Type Unspecified