Provider Demographics
NPI:1588752166
Name:NIEBYL, PETER H (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:H
Last Name:NIEBYL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 CAULK LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3808
Mailing Address - Country:US
Mailing Address - Phone:410-822-8223
Mailing Address - Fax:410-822-1423
Practice Address - Street 1:4 CAULK LN
Practice Address - Street 2:SUITE B
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3808
Practice Address - Country:US
Practice Address - Phone:410-822-8223
Practice Address - Fax:410-822-1423
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0019374207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD171211ZFQEMedicare PIN
MD6412Medicare ID - Type Unspecified