Provider Demographics
NPI:1295712016
Name:CHIRICO, PETER ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:CHIRICO
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 910
Mailing Address - Street 2:RADIOLOGY INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:3448 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2906
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY317522085R0202X
OH35.0809022085R0202X
WV165692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV300021806OtherRAILROAD MEDICARE
KY50007249OtherPASSPORT
OH000000196624OtherUNISON
WV55049337600OtherWORKMANS COMP
WV0118638000Medicaid
KY6469839200Medicaid
4326610OtherAETNA
OH0826860Medicaid
001718772OtherMTN STATE BCBS
4326610OtherAETNA
E69620Medicare UPIN
WV300021806OtherRAILROAD MEDICARE
WV0118638000Medicaid