Provider Demographics
NPI:1649231481
Name:DARWIN, PETER EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:EDWIN
Last Name:DARWIN
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:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-8729
Mailing Address - Fax:410-328-8315
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-8729
Practice Address - Fax:410-328-8315
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42781207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD534386-02 & 01OtherBLUE CROSS/BLUE SHIELD
DC034348300Medicaid
WV3810000273Medicaid
DE1649231481Medicaid
MD220171200Medicaid
DE1649231481Medicaid
DC034348300Medicaid
MDS646873LMedicare PIN