Individual
DR. PETER CACCAVALLO
Active
Individual
DR. PETER CACCAVALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1053181A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000287592
ANTHEM ID NUMBER
IN
05
—
200316800
—
IN
01
—
51-0456750
TAX ID
IN
01
—
P00013960
RAILROAD MEDICARE
IN
Enumeration date
01/16/2007
Last updated
07/14/2014
Update your record
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