Provider Demographics
NPI:1649242496
Name:CUESTA, PETER JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
Last Name:CUESTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11021 NICHOLAS LN
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OCEAN PINES
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3244
Mailing Address - Country:US
Mailing Address - Phone:410-208-4878
Mailing Address - Fax:410-208-4877
Practice Address - Street 1:11021 NICHOLAS LN
Practice Address - Street 2:SUITE 6
Practice Address - City:OCEAN PINES
Practice Address - State:MD
Practice Address - Zip Code:21811-3244
Practice Address - Country:US
Practice Address - Phone:410-208-4878
Practice Address - Fax:410-208-4877
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01351213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4008677 00Medicaid
MD4681810001Medicare NSC
MD4008677 00Medicaid
MD952RMedicare PIN