Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA05859400 | NJ |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD039877E | PA |
NPI | 1013954262 |
---|---|
Provider Name | Peter Francis Deluca |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 10/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0040288200 | IBC (01) | PA |
0400517000 | IBC (01) | NJ |
3954367 | AETNA (01) | NJ |
3955222 | AETNA (01) | PA |
6197745 | CIGNA (01) | |
E73122 | (02) |