Provider Demographics
NPI:1780664292
Name:PETERLIN, BARBARA LEE II (DO)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEE
Last Name:PETERLIN
Suffix:II
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GRANDVIEW AVENUE SUITE 206
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-745-6223
Mailing Address - Fax:717-745-6224
Practice Address - Street 1:205 GRANDVIEW AVE STE 206
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1708
Practice Address - Country:US
Practice Address - Phone:717-745-6223
Practice Address - Fax:717-745-6224
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH707132084N0400X
PAOS010064L2084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036672200Medicaid
NJ0081469Medicaid
NJ095980C66Medicare ID - Type Unspecified
NJ095980MX2Medicare ID - Type Unspecified
MD036672200Medicaid
NJ0081469Medicaid