Provider Demographics
NPI:1639283336
Name:ELY, PETER K (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:ELY
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 1:7 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-8757
Mailing Address - Country:US
Mailing Address - Phone:828-298-3386
Mailing Address - Fax:
Practice Address - Street 1:7 OAK HOLLOW DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-8757
Practice Address - Country:US
Practice Address - Phone:828-298-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG492650207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G492650Medicare ID - Type Unspecified