Provider Demographics
NPI:1992887913
Name:CELLUCCI, PETER K (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:CELLUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:92 HIGHLAND ST
Mailing Address - Street 2:MILTON HOSPITAL EMERGENCY DEPT
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3800
Mailing Address - Country:US
Mailing Address - Phone:617-313-1615
Mailing Address - Fax:
Practice Address - Street 1:92 HIGHLAND ST
Practice Address - Street 2:MILTON HOSPITAL EMERGENCY DEPT
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3800
Practice Address - Country:US
Practice Address - Phone:617-313-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55452207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE22158Medicare UPIN