Provider Demographics
NPI:1891793873
Name:DEPPERT, ERIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:DEPPERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 BALTIMORE PIKE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2800
Mailing Address - Country:US
Mailing Address - Phone:610-690-1776
Mailing Address - Fax:610-690-1777
Practice Address - Street 1:1001 BALTIMORE PIKE
Practice Address - Street 2:SUITE 109
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2800
Practice Address - Country:US
Practice Address - Phone:610-690-1776
Practice Address - Fax:610-690-1777
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-11-10
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Provider Licenses
StateLicense IDTaxonomies
PAMD047585L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014085330001Medicaid
PA0014085330001Medicaid
PAF52937Medicare UPIN