Provider Demographics
NPI:1013909340
Name:STAATS, PETER S (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:STAATS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11350 MCCORMICK ROAD
Mailing Address - Street 2:, EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:160 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 1
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-380-0200
Practice Address - Fax:732-380-0124
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA07692700207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG31807Medicare UPIN