Provider Demographics
NPI:1235441833
Name:VIA, PETER FRANCIS (PA-C)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:FRANCIS
Last Name:VIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 MEMORIAL DR STE 6
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7056
Mailing Address - Country:US
Mailing Address - Phone:814-623-4313
Mailing Address - Fax:814-623-1893
Practice Address - Street 1:195 MEMORIAL DR STE 6
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7056
Practice Address - Country:US
Practice Address - Phone:814-624-4313
Practice Address - Fax:814-623-1893
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014022363A00000X
PAMA056417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant