Provider Demographics
NPI:1922108695
Name:ZANGARA, PETER P (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:ZANGARA
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 1:3949 SUNFOREST CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4473
Mailing Address - Country:US
Mailing Address - Phone:419-475-9341
Mailing Address - Fax:419-474-0095
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:SUITE 105
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4473
Practice Address - Country:US
Practice Address - Phone:419-475-9341
Practice Address - Fax:419-474-0095
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350460562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454762Medicaid
OH0454762Medicaid
OHA79948Medicare UPIN
OHZA0492412Medicare ID - Type Unspecified