Provider Demographics
NPI:1679549620
Name:DEVITO, PETER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:DEVITO
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 1:7600 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6085
Mailing Address - Country:US
Mailing Address - Phone:330-758-3985
Mailing Address - Fax:330-758-4264
Practice Address - Street 1:7600 SOUTHERN BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6085
Practice Address - Country:US
Practice Address - Phone:330-758-3985
Practice Address - Fax:330-758-4264
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-64590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259376Medicaid
OHG27405Medicare UPIN