Provider Demographics
NPI:1467438366
Name:PETERS, JEROME ALBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:ALBERT
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4968 CLINE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-9246
Mailing Address - Country:US
Mailing Address - Phone:724-387-1252
Mailing Address - Fax:
Practice Address - Street 1:330 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2235
Practice Address - Country:US
Practice Address - Phone:724-832-7800
Practice Address - Fax:724-832-8333
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025418E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183209Medicare ID - Type Unspecified
PAC32991Medicare UPIN