Provider Demographics
NPI:1316908478
Name:FAMIGLIO, PETER M (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:FAMIGLIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DOWLIN FORGE RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1548
Mailing Address - Country:US
Mailing Address - Phone:610-363-7000
Mailing Address - Fax:610-363-7687
Practice Address - Street 1:25 DOWLIN FORGE RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1548
Practice Address - Country:US
Practice Address - Phone:610-363-7000
Practice Address - Fax:610-363-7687
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026077L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000525541OtherBC/BS INDIVIDUAL #
PA0227912000OtherBC/BS PRACTICE HMO #
PA000159506OtherBC/BS GROUP #
PA0113323000OtherBC/BS INDIVIDUAL HMO#
PA0227912000OtherBC/BS PRACTICE HMO #
PA525541Medicare ID - Type Unspecified