Provider Demographics
NPI:1780660852
Name:TARASCHI, PETER WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAM
Last Name:TARASCHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 S APOLLO BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:6100 MINTON RD NW
Practice Address - Street 2:STE 102
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1975
Practice Address - Country:US
Practice Address - Phone:321-724-1171
Practice Address - Fax:321-724-9024
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4958208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22802OtherWELLCARE
FL4074220OtherAETNA
FL010055010OtherRAILROAD MEDICARE
FL120527400Medicaid
FL82901OtherBLUE CROSS BLUE SHIELD
FL9062915005OtherCIGNA
FL2138296OtherAETNA
FL257321100Medicaid
D60763Medicare UPIN