Provider Demographics
NPI:1578518049
Name:MUSCARELLA, PETER II (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:MUSCARELLA
Suffix:II
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 1:620 10TH ST STE 704
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1841
Mailing Address - Country:US
Mailing Address - Phone:716-278-4402
Mailing Address - Fax:716-278-4364
Practice Address - Street 1:620 10TH ST STE 704
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1841
Practice Address - Country:US
Practice Address - Phone:716-278-4402
Practice Address - Fax:716-278-4364
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275955208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04157544Medicaid
OH0180950Medicaid
OH0180950Medicaid