Healthcare Provider Details

I. General information

NPI: 1124346044
Provider Name (Legal Business Name): PETER J CUESTA, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11021 NICHOLAS LN SUITE 6
OCEAN PINES MD
21811-3243
US

IV. Provider business mailing address

11021 NICHOLAS LN SUITE 6
OCEAN PINES MD
21811-3243
US

V. Phone/Fax

Practice location:
  • Phone: 410-208-4878
  • Fax: 410-208-4877
Mailing address:
  • Phone: 410-208-4878
  • Fax: 410-208-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: PETER J CUESTA
Title or Position: PRESIDENT
Credential: DPM
Phone: 410-208-4878