Provider Demographics
NPI:1508970757
Name:PETERS, LIDIA ELISABETA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:ELISABETA
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8464
Mailing Address - Country:US
Mailing Address - Phone:570-372-5837
Mailing Address - Fax:
Practice Address - Street 1:1000 ROUTE 522
Practice Address - Street 2:SELINSGROVE CENTER
Practice Address - City:SELINGSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8707
Practice Address - Country:US
Practice Address - Phone:570-372-5837
Practice Address - Fax:570-372-5855
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 060446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG 44974Medicare UPIN
PA706923Medicare PIN