Basic Information
| Provider Information | |||||||||
| NPI: | 1114970597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIZZUTILLO | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | DARRELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 926 BOWMAN AVE | ||||||||
| Address2: | |||||||||
| City: | WYNNEWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190961658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154273131 | ||||||||
| FaxNumber: | 2154278782 | ||||||||
| Practice Location | |||||||||
| Address1: | ST.CHRISTOPHER'S HOSPITAL FOR CHILDREN, 3601 A STREET | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154273423 | ||||||||
| FaxNumber: | 2154278782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/27/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD102652E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0010367410009 | 05 | PA | MEDICAID |