Provider Demographics
NPI:1629024708
Name:FAVINI, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:FAVINI
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 1:1872 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5669
Mailing Address - Country:US
Mailing Address - Phone:484-503-1200
Mailing Address - Fax:484-503-1206
Practice Address - Street 1:1872 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5669
Practice Address - Country:US
Practice Address - Phone:484-503-1200
Practice Address - Fax:484-503-1206
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031795E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000963690003Medicaid
PA930092699OtherRAILROAD MEDICARE
PAFA108883OtherBLUE SHIELD
PA000963690003Medicaid
PA108883N46Medicare PIN