Provider Demographics
NPI:1861477192
Name:CORDA, PETER DENNIS (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DENNIS
Last Name:CORDA
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:PO BOX 8890
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-0453
Mailing Address - Country:US
Mailing Address - Phone:856-740-4888
Mailing Address - Fax:
Practice Address - Street 1:2007 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-9120
Practice Address - Country:US
Practice Address - Phone:856-740-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04459800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076810Medicare ID - Type Unspecified
E60696Medicare UPIN