Healthcare Provider Details

I. General information

NPI: 1982704342
Provider Name (Legal Business Name): PETER J COSTANTINI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10614 RACETRACK ROAD
BERLIN MD
21811
US

IV. Provider business mailing address

10026 OLD OCEAN CITY BLVD BUILDING #1
BERLIN MD
21811-1288
US

V. Phone/Fax

Practice location:
  • Phone: 410-208-9761
  • Fax: 410-208-9764
Mailing address:
  • Phone: 410-641-9450
  • Fax: 410-641-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MB03627200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MB03627200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberH0074232
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: