Provider Demographics
NPI:1184625287
Name:COLUCIO, PETER M (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:COLUCIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:SUMMIT MEDICAL GROUP
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:908-277-8841
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:SUMMIT MEDICAL GROUP
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8625
Practice Address - Fax:908-277-8841
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-07-09
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Provider Licenses
StateLicense IDTaxonomies
NJMA49588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE53133Medicare UPIN
NJ545312BSDMedicare ID - Type UnspecifiedMEDICARE#