Provider Demographics
NPI:1861472680
Name:GO, PETER T (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:GO
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 1:867 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1235
Mailing Address - Country:US
Mailing Address - Phone:814-445-3469
Mailing Address - Fax:814-445-4500
Practice Address - Street 1:867 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1235
Practice Address - Country:US
Practice Address - Phone:814-445-3469
Practice Address - Fax:814-445-4500
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039319L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010826000001Medicaid
PA197636QKSMedicare PIN
PAB41124Medicare UPIN