Provider Demographics
NPI:1841299054
Name:INTRIERI, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:INTRIERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045537E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA212567OtherUPMC
NY00025197101OtherUNIVERA
WV1068778OtherW. VIRGINIA WORKERS COMP
PA609498OtherBLUE SHIELD
PA847797OtherAETNA
NY01861123OtherNY MEDICAL ASSISTANCE
OH0889721OtherOH MEDICAL ASSISTANCE
PA930051156OtherRR MEDICARE
PA0012043280007Medicaid
PA1510455OtherGATEWAY
PA71316OtherUNISON
NY00025197101OtherUNIVERA
PA609498E7CMedicare PIN