Provider Demographics
NPI:1710921812
Name:ALDEA, PETER A (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:ALDEA
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 1:8541 HAWKSPRINGS CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7625
Mailing Address - Country:US
Mailing Address - Phone:901-752-1412
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-752-1412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26228208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF93449Medicare UPIN
TN3087482Medicare ID - Type UnspecifiedMEDICARE NUMBER