Provider Demographics
NPI:1811943335
Name:HANNON, PETER (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:HANNON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 EAST MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-3478
Practice Address - Country:US
Practice Address - Phone:570-808-7856
Practice Address - Fax:570-808-1069
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007131L207R00000X, 208M00000X
UT12826434-1204207RC0200X
NY195753207RC0200X
PAOS-007131-L207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50073483OtherKEYSTONE HEALTH PLAN
PAHA425022OtherHIGHMARK BLUE SHIELD
PA232809429008OtherTRICARE
PA0013918390006Medicaid
PA50073483OtherCAPITAL BLUE CROSS
PA1689OtherGEISINGER
PAHA425022OtherHIGHMARK BLUE SHIELD
PA50073483OtherKEYSTONE HEALTH PLAN