Provider Demographics
NPI:1801968011
Name:PELTAN, HAROLD LEE (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LEE
Last Name:PELTAN
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:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-1269
Mailing Address - Country:US
Mailing Address - Phone:662-545-4600
Mailing Address - Fax:662-545-4588
Practice Address - Street 1:425B N DAVIS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2351
Practice Address - Country:US
Practice Address - Phone:662-545-4600
Practice Address - Fax:662-545-4588
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-6780-P207W00000X
PAMD-071663-L207W00000X
IN01049615A207W00000X
MS20927207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology