Provider Demographics
NPI:1831135243
Name:SCHISSLER, PETER MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MARTIN
Last Name:SCHISSLER
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 1:7500 GREENWAY CENTER DR
Mailing Address - Street 2:STE 430
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3502
Mailing Address - Country:US
Mailing Address - Phone:301-345-5857
Mailing Address - Fax:301-474-5621
Practice Address - Street 1:7500 GREENWAY CENTER DR
Practice Address - Street 2:STE 430
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-345-5857
Practice Address - Fax:301-474-5621
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD22780207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPTAN 0265590001OtherOTHER PROVIDER
MD791841100Medicaid
MD0265590001Medicare NSC
MDB94713Medicare UPIN
SCPTAN 0265590001OtherOTHER PROVIDER