MEDICARE: MR. PETER E KOLONE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2023-A	AS

General Provider Information

NPI Number	:	1912990615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER E KOLONE PA

Provider Business Mailing Address
First Line	:	P.O. BOX LBJ GENERAL DELIVERY
Second Line	:	LBJ TROPICAL MEDICAL CENTER
City	:	PAGO PAGO
State	:	AS
Zip	:	96799
Country	:	US
Telephone Number	:	684-633-1683
Fax Number	:	684-633-1976

Provider Business Practice Location Address
First Line	:	123 TURNER DRIVE
Second Line	:
City	:	PAGO PAGO
State	:	AS
Zip	:	96799
Country	:	US
Telephone Number	:	684-633-1683
Fax Number	:	684-633-1976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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