Provider Demographics
NPI:1689785222
Name:KING, PETER L (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:KING
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 1:1006 SUGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1800
Mailing Address - Country:US
Mailing Address - Phone:610-296-7657
Mailing Address - Fax:
Practice Address - Street 1:2245 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1101
Practice Address - Country:US
Practice Address - Phone:610-623-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002869L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003563OtherBLUE SHIELD PROVIDER I.D.
PA48006220OtherRAILROAD MEDICARE I.D.
PA0921260002OtherNHIC PROVIDER I.D.
PA01991OtherHEALTH PARTNERS I.D.
PA55554OtherU.S. HEALTHCARE I.D.
PA31747OtherKEYSTONE MERCY HEALTH
PA325OtherELDER HEALTH I.D.
PAJ03563OtherAMERIHEALTH PROVIDER ID
PA0060355000OtherKEYSTONE HPE I.D.
PA0060355000OtherPERSONAL CHOICE I.D.
PA0109711002OtherAMERICHOICE I.D.
PA01991OtherSENIOR PARTNERS I.D.
PA0010971100001Medicaid
PA31747OtherKEYSTONE MERCY HEALTH
PA0921260002OtherNHIC PROVIDER I.D.
PA0010971100001Medicaid