Provider Demographics
NPI:1366425092
Name:FUMO, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:FUMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E MORELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3562
Mailing Address - Country:US
Mailing Address - Phone:267-385-5538
Mailing Address - Fax:267-437-3176
Practice Address - Street 1:10 E MORELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3562
Practice Address - Country:US
Practice Address - Phone:267-437-3163
Practice Address - Fax:267-437-3176
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045122E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017142320003Medicaid
PA0715867000OtherPERSONAL CHOICE
PACA1374OtherRAILROAD MEDICARE
PA0715867000OtherKEYSTONE HEALTH PLAN EAST
PA504883OtherAETNA
PA009627OtherHIGHMARK BLUE SHIELD
PA0171423205OtherAMERICHOICE
PA1016996OtherKEYSTONE MERCY
PA12945MD045122EOtherHEALTH PARTNERS
PAF90697Medicare UPIN
PA1016996OtherKEYSTONE MERCY