1972690618 NPI number — DR. PETER MICHAEL PILLITTERI M.D., FACEP

Table of content: DR. PETER MICHAEL PILLITTERI M.D., FACEP (NPI 1972690618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972690618 NPI number — DR. PETER MICHAEL PILLITTERI M.D., FACEP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PILLITTERI
Provider First Name:
PETER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., FACEP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972690618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 COURT STEET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-746-6162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JORDAN HOSPITAL ER
Provider Second Line Business Practice Location Address:
275 SANDWICH STREET
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-830-2800
Provider Business Practice Location Address Fax Number:
508-830-2836
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X , with the licence number:  75647 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 75647 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3105661 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J13363 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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