MEDICARE: PETER M MEZZACAPPA M.D.

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	2085R0202X	Diagnostic Radiology Physician	25MA05419000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356363808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER M MEZZACAPPA M.D.

Provider Business Mailing Address
First Line	:	619 ALEXANDER RD
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-6000
Country	:	US
Telephone Number	:	732-821-5563
Fax Number	:	732-821-3250

Provider Business Practice Location Address
First Line	:	901 W MAIN ST
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2537
Country	:	US
Telephone Number	:	732-462-4844
Fax Number	:	732-462-9482

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/27/2026

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