Provider Demographics
NPI:1194699744
Name:THARP, PETER BENJAMIN
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:BENJAMIN
Last Name:THARP
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 1:923 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2723
Mailing Address - Country:US
Mailing Address - Phone:619-312-7313
Mailing Address - Fax:
Practice Address - Street 1:923 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2723
Practice Address - Country:US
Practice Address - Phone:619-312-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5238364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist