Provider Demographics
NPI:1104857747
Name:AMEGLIO, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:AMEGLIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6839 PORTO FINO CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4361
Mailing Address - Country:US
Mailing Address - Phone:239-990-8138
Mailing Address - Fax:239-237-3180
Practice Address - Street 1:6839 PORTO FINO CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4361
Practice Address - Country:US
Practice Address - Phone:239-990-8138
Practice Address - Fax:238-237-3180
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131013207X00000X, 207XX0004X
NH11232207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201606Medicaid
NHH17391OtherHARVARD PILGRIM
NH020473740OtherUNITED HEALTHCARE
NH2924920OtherCIGNA
NH020473740OtherHUMANA CHOICE CARE NETWOR
NH020473740OtherPRIVATE HEALTHCARE SYSTEM
NH020473740OtherGREAT WEST HEALTHCARE
NH01Y003265NH01OtherANTHEM
NH020473740OtherTRICARE
NH2625636OtherAETNA
NH020473740OtherHEALTHCARE VALUE MGMT
NH200041347OtherRAILROAD MEDICARE
NH01Y003265NH01OtherANTHEM
NH2924920OtherCIGNA