Provider Demographics
NPI:1952363400
Name:SPOHN, PETER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:SPOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:51 COLONY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-3107
Mailing Address - Country:US
Mailing Address - Phone:843-618-8356
Mailing Address - Fax:
Practice Address - Street 1:50 MOISEY DR STE 202
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-9297
Practice Address - Country:US
Practice Address - Phone:570-501-6730
Practice Address - Fax:570-501-3837
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458037207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103260374Medicaid
PA103260374Medicaid