Provider Demographics
NPI:1376546705
Name:PLESS, PETER R (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:PLESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:505 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3057
Mailing Address - Country:US
Mailing Address - Phone:814-333-5875
Mailing Address - Fax:814-333-5893
Practice Address - Street 1:505 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3057
Practice Address - Country:US
Practice Address - Phone:814-333-5875
Practice Address - Fax:814-333-5893
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043713E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA205031OtherUPMC HEALTH PLAN
PA251754199019OtherMEDICAL MUTUAL OF OHIO
PA6371345OtherCIGNA
PA902561OtherHIGHMARK BLUE CROSS SHIELD
PAE15023OtherHEALTH AMERICA
PA4235190002OtherNATIONAL SUPPLIERS CLEARINGHOUSE
PA0011630920001Medicaid
PA070008157OtherPALMETTO GBA-RAILROAD MEDICARE
PA182993Medicare PIN
PA205031OtherUPMC HEALTH PLAN