Provider Demographics
NPI:1942249842
Name:OSSANNA, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:OSSANNA
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 1:50 UNION ST
Mailing Address - Street 2:MAINE COAST MEMORIAL HOSPITAL
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:207-664-5480
Mailing Address - Fax:207-664-5490
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:MAINE COAST MEMORIAL HOSPITAL
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1586
Practice Address - Country:US
Practice Address - Phone:207-664-5480
Practice Address - Fax:207-664-5490
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM379202Medicare PIN
MEMM3792Medicare PIN
MEE90615Medicare UPIN
MEMM379201Medicare PIN