Healthcare Provider Details

I. General information

NPI: 1114970597
Provider Name (Legal Business Name): PETER DARRELL PIZZUTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST.CHRISTOPHER'S HOSPITAL FOR CHILDREN, 3601 A STREET
PHILADELPHIA PA
19134
US

IV. Provider business mailing address

926 BOWMAN AVE
WYNNEWOOD PA
19096-1658
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-3423
  • Fax: 215-427-8782
Mailing address:
  • Phone: 215-427-3131
  • Fax: 215-427-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD102652E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: