Provider Demographics
NPI:1700826690
Name:BOHN, ERIC SEAN (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SEAN
Last Name:BOHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 IRMC DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:UM
Mailing Address - Phone:724-465-2676
Mailing Address - Fax:724-349-1830
Practice Address - Street 1:120 IRMC DR
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3674
Practice Address - Country:US
Practice Address - Phone:724-427-2260
Practice Address - Fax:724-427-2707
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011801207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019535180007Medicaid
PA068962Medicare ID - Type Unspecified
PA0019535180007Medicaid