Provider Demographics
NPI:1730392564
Name:PETER ACCETTA, M.D.
Entity type:Organization
Organization Name:PETER ACCETTA, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRITOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-675-7000
Mailing Address - Street 1:3045 SOUTHWESTERN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1209
Mailing Address - Country:US
Mailing Address - Phone:716-675-7000
Mailing Address - Fax:716-674-4659
Practice Address - Street 1:3065 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1239
Practice Address - Country:US
Practice Address - Phone:716-675-7000
Practice Address - Fax:716-675-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA5994Medicare ID - Type Unspecified