Provider Demographics
NPI:1255343448
Name:APPENZELLER, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:APPENZELLER
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:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5654
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:PATHOLOGY ASSOCIATES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-841-1259
Practice Address - Fax:505-841-1373
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99157207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67534228Medicaid
NMNM301652Medicare PIN
NMA090001072Medicare PIN
NM347712204Medicare PIN
NMS003201038Medicare PIN
NM67534228Medicaid
NM$$$$$$$$$Medicare PIN
NMNM301665Medicare PIN