Individual
PETER JOHN MUSTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 S 18TH ST, COLUMBUS, OH 43205-2654
(614) 722-6200
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
35073238
OH
208000000X
Pediatrics Physician
35073238
OH
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
35073238
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2154403
—
OH
05
—
3004870000
—
WV
05
—
64047764
—
KY
01
—
H229700
CGS - MEDICARE
OH
Enumeration date
09/06/2005
Last updated
02/15/2022
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