Provider Demographics
NPI:1316132897
Name:DELENICK, PETER JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:DELENICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:441 PINEY FOREST RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4154
Mailing Address - Country:US
Mailing Address - Phone:434-793-0700
Mailing Address - Fax:434-793-9315
Practice Address - Street 1:441 PINEY FOREST RD
Practice Address - Street 2:SUITE G
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4154
Practice Address - Country:US
Practice Address - Phone:434-793-0700
Practice Address - Fax:434-793-9315
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ43968207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03098024Medicaid
NYJ300000139Medicare PIN
VA015639Medicare PIN