Provider Demographics
NPI:1477260701
Name:REPPENHAGEN, PIETER (PA-C)
Entity Type:Individual
Prefix:
First Name:PIETER
Middle Name:
Last Name:REPPENHAGEN
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 TURNPIKE ST STE 11
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5937
Mailing Address - Country:US
Mailing Address - Phone:978-794-1946
Mailing Address - Fax:
Practice Address - Street 1:16 PELHAM RD STE 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3077
Practice Address - Country:US
Practice Address - Phone:978-794-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2023-07-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant