Individual
PETER SCUCCIMARRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1655 HOLLAND RD STE F, MAUMEE, OH 43537-1656
(833) 510-4357
Mailing address
615 ELSINORE PL STE 200, CINCINNATI, OH 45202-1457
(513) 834-7063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301047163
MI
207QA0401X
Addiction Medicine (Family Medicine) Physician
4301047163
MI
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
35.146077
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0811926
BLUE CROSS/BLUE SHIELD
MI
Enumeration date
03/27/2006
Last updated
07/12/2022
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