Provider Demographics
NPI:1427168137
Name:MARCHETTI, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MARCHETTI
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 1:29448 HEMLOCK LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4885
Mailing Address - Country:US
Mailing Address - Phone:410-822-8193
Mailing Address - Fax:
Practice Address - Street 1:508 MARYLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1930
Practice Address - Country:US
Practice Address - Phone:410-901-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21012OtherLICENSE #