Healthcare Provider Details

I. General information

NPI: 1366795080
Provider Name (Legal Business Name): PETER SYKORA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH ST
PHILADELPHIA PA
19107-4824
US

IV. Provider business mailing address

111 S 11TH ST
PHILADELPHIA PA
19107-4824
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-2370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOT0152301
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: