Provider Demographics
NPI:1770580144
Name:COVELESKI, PETER JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:COVELESKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 S BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4141
Mailing Address - Country:US
Mailing Address - Phone:302-422-0800
Mailing Address - Fax:
Practice Address - Street 1:111 NEUROLOGY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963
Practice Address - Country:US
Practice Address - Phone:302-422-0800
Practice Address - Fax:888-990-1108
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20003573208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000499403Medicaid
DEF59566Medicare UPIN
DE0000499403Medicaid