MEDICARE: DR. PETER WILLIAM TARASCHI DO

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	207Q00000X	Family Medicine Physician	OS4958	FL
2	208D00000X	General Practice Physician	OS4958	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	010055010	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22802	OTHER	FL	WELLCARE
2	82901	OTHER	FL	BLUE CROSS BLUE SHIELD
3	9062915005	OTHER	FL	CIGNA
4	2138296	OTHER	FL	AETNA
5	4074220	OTHER	FL	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780660852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER WILLIAM TARASCHI DO

Provider Business Mailing Address
First Line	:	1344 S APOLLO BLVD STE 406
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-727-2990
Fax Number	:	321-724-0455

Provider Business Practice Location Address
First Line	:	6100 MINTON RD NW
Second Line	:	STE 102
City	:	PALM BAY
State	:	FL
Zip	:	32907-1975
Country	:	US
Telephone Number	:	321-724-1171
Fax Number	:	321-724-9024

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	10/01/2025

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