Provider Demographics
NPI:1871643353
Name:IARIA, PETER GREGORY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:GREGORY
Last Name:IARIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6604 SOUTHERN CROSS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3908
Mailing Address - Country:US
Mailing Address - Phone:317-417-4449
Mailing Address - Fax:
Practice Address - Street 1:CAMP ATTERBURY TROOP MEDICAL CLINIC
Practice Address - Street 2:BUILDING 2
Practice Address - City:EDINBURGH
Practice Address - State:IN
Practice Address - Zip Code:46124
Practice Address - Country:US
Practice Address - Phone:812-526-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000468A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant