Provider Demographics
NPI:1518046325
Name:DILLON, PETER A (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:DILLON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-245-3107
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:260 STETSON ST
Practice Address - Street 2:MAIL LOCATIN 0559
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2498
Practice Address - Country:US
Practice Address - Phone:513-558-7700
Practice Address - Fax:513-558-5449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5603103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2242219Medicaid
S99033Medicare UPIN
OHDICP23651Medicare PIN