Provider Demographics
NPI:1316943996
Name:MORNINGSTAR, PETER E (MC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:MORNINGSTAR
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2291
Mailing Address - Country:US
Mailing Address - Phone:207-764-5437
Mailing Address - Fax:207-764-4760
Practice Address - Street 1:23 NORTH ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2291
Practice Address - Country:US
Practice Address - Phone:207-764-5437
Practice Address - Fax:207-764-4760
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016420208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3566877OtherAETNA
ME023021OtherANTHEM BLUE CROSS
ME410210099Medicaid
ME3566877OtherAETNA
MEME0722Medicare ID - Type Unspecified