Provider Demographics
NPI:1790737666
Name:OH, PETER S (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:OH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:4131A OREGON PIKE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9550
Practice Address - Country:US
Practice Address - Phone:717-859-1123
Practice Address - Fax:717-859-2898
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006535L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021128500001Medicaid
50077763OtherCAPTIAL BLUE CROSS
2035058OtherHIGHMARK/FREEDOM BLUE
P009497OtherGATEWAY
125196UFWMedicare PIN