Provider Demographics
NPI:1013954262
Name:DELUCA, PETER FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:FRANCIS
Last Name:DELUCA
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 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:925 CHESTNUT ST, FL 5
Practice Address - Street 2:ROTHMAN INSTITUTE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:267-339-3500
Practice Address - Fax:215-503-0580
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05859400207X00000X, 207XX0005X
PAMD039877E207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3954367OtherAETNA
NJ0400517000OtherIBC
PA3955222OtherAETNA
PA0040288200OtherIBC
6197745OtherCIGNA
PA3955222OtherAETNA
NJP00239881Medicare PIN
E73122Medicare UPIN
PA000667GC6Medicare ID - Type Unspecified
NJ578937PFCMedicare ID - Type Unspecified