Provider Demographics
NPI:1386681559
Name:PETERS, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1800 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2369
Practice Address - Country:US
Practice Address - Phone:570-969-0161
Practice Address - Fax:570-969-0163
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021153E207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009152810Medicaid
PA075297OtherFIRST PRIORITY
PA1636787OtherBLACK LUNG
PA290000700OtherRAILROAD MEDICARE
PA000003351OtherBLUE SHIELD
PA13223-1770OtherGEISINGER HEALTH PLAN
PA1636787OtherBLACK LUNG
PA290000700OtherRAILROAD MEDICARE
PA003351Medicare ID - Type Unspecified