MEDICARE: PETER A ACCETTA 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35052142	OH

General Provider Information

NPI Number	:	1972504827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER A ACCETTA M.D.

Provider Business Mailing Address
First Line	:	P O BOX 636042 DEPT 6042
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	614-566-4945
Fax Number	:	614-263-1056

Provider Business Practice Location Address
First Line	:	3535 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3908
Country	:	US
Telephone Number	:	614-566-4945
Fax Number	:	614-263-1056

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/08/2007

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