Individual provider Active NPI

Morris Peterzell, D.O.

  • Family Medicine Physician
  • Wilmington, DE
National Provider Identifier
1982646063
Registry record updated Feb 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C2-0006422 Issued in DE
Practice address
1600 N Washington St
2ND Floor
Wilmington, DE 19802-4722
Phone
(302) 658-8885
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C2-0006422 DE Primary

Addresses

Primary practice location

1600 N Washington St
2ND Floor
Wilmington, DE 19802-4722

Mailing address

1600 N Washington St
2ND Floor
Wilmington, DE 19802-4722
Phone (302) 658-8885

Other identifiers 1

IdentifierTypeStateIssuer
1000014077MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
C2-0006422DEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kyle Ukrainyc DC LLC CurrentSince Sep 24, 2020 Accepting new patients

Locations

1600 N Washington St
#2
Wilmington, DE 19802
Phone (302) 658-8885

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204156800000",
    "number": "1982646063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N WASHINGTON ST",
            "address_2": "2ND FLOOR",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198024722",
            "telephone_number": "302-658-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N WASHINGTON ST",
            "address_2": "2ND FLOOR",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198024722",
            "telephone_number": "302-658-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERZELL",
        "first_name": "MORRIS",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2008-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C2-0006422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000014077",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.