Provider Demographics
NPI:1932279676
Name:PEPPARD, SEAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:B
Last Name:PEPPARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3335
Mailing Address - Country:US
Mailing Address - Phone:610-372-8044
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-741-0310
Practice Address - Fax:610-741-0311
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028624207Y00000X
PAMD442066207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA297051OtherWELL CARE
GA000320471BOtherPEACH STATE
PA102573801Medicaid
GA000320471BMedicaid
GA52235853OtherBCBS #
GA52235853OtherBCBS #
PA213760Medicare PIN
GA000320471BMedicaid