Provider Demographics
NPI:1740931252
Name:PETER A DICORLETO MD PC
Entity type:Organization
Organization Name:PETER A DICORLETO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACITICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-431-6998
Mailing Address - Street 1:PO BOX 2050
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-2050
Mailing Address - Country:US
Mailing Address - Phone:813-931-0000
Mailing Address - Fax:813-709-7162
Practice Address - Street 1:1832 WARD DR STE 102
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0570
Practice Address - Country:US
Practice Address - Phone:615-893-0790
Practice Address - Fax:615-893-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty