Provider Demographics
NPI:1548227127
Name:DICHIARA, PETER M (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:DICHIARA
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 1:1350 HIGHWAY 231 S
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3058
Mailing Address - Country:US
Mailing Address - Phone:334-566-1270
Mailing Address - Fax:334-566-1296
Practice Address - Street 1:1350 HIGHWAY 231 S
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3058
Practice Address - Country:US
Practice Address - Phone:334-566-1270
Practice Address - Fax:334-566-1296
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0410726OtherUNITED HEALTHCARE
AL110096629OtherRR MEDICARE
AL000014377Medicaid
AL015114377OtherBLUE CROSS
14377OtherHUMANA
AL000014377Medicare PIN