Provider Demographics
NPI:1124346044
Name:PETER J CUESTA, DPM, PA
Entity type:Organization
Organization Name:PETER J CUESTA, DPM, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUESTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-208-4878
Mailing Address - Street 1:11021 NICHOLAS LN
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OCEAN PINES
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3243
Mailing Address - Country:US
Mailing Address - Phone:410-208-4878
Mailing Address - Fax:410-208-4877
Practice Address - Street 1:11021 NICHOLAS LN
Practice Address - Street 2:SUITE 6
Practice Address - City:OCEAN PINES
Practice Address - State:MD
Practice Address - Zip Code:21811-3243
Practice Address - Country:US
Practice Address - Phone:410-208-4878
Practice Address - Fax:410-208-4877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER J CUESTA, DPM, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400867700Medicaid
MD952RMedicare PIN