DR. ERIC EVAN PETTERSON (NPI# 1245269547) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245269547 |
| Entity Type | Individual |
| Full Name | DR. ERIC EVAN PETTERSON |
| Credential | MD |
| Practice Address |
4 W Washington St Shenandoah PA 17976-1707 |
| Mailing Address |
411 W Pine St Mahanoy City PA 17948-2515 |
| Practice Telephone | 5704621040 |
| Practice Fax Number | 5704621040 |
| Mailing Telephone | 5708610802 |
| Mailing Fax Number | 5704621040 |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2017-01-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | MD039636L | PA | Allopathic & Osteopathic Physicians |
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
MD039636L | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 0010036980006 | 05 |
| Street Address |
4 W WASHINGTON ST |
| City | SHENANDOAH |
| State | PA |
| Zip Code | 17976-1707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063561041 | Main Street Medical Center Inc | Internal Medicine | 24 South Main Street, Shenandoah, PA 17976 | 2007-01-09 |
| 1518417690 | Eric E. Petterson P.C. | Internal Medicine | 1 S Main St, Shenandoah, PA 17976 | 2016-10-12 |
| 1770875940 | Patricia Ce Domin-shorten | Pharmacist | 42 Main Street, Rite Aid Pharmacy, Shenandoah, PA 17976 | 2011-05-06 |
| 1962603605 | Alexine M Rajnic | Speech-Language Pathologist | 101 E Washington St, Shenandoah Manor Nursing Home, Shenandoah, PA 17976 | 2007-05-30 |
| 1003296997 | Sherley Vasquez | Physical Therapist | 201 Swatara Rd, Shenandoah, PA 17976-1232 | 2015-06-04 |
| 1730139460 | Trinity Mission of Shenandoah Heights, LLC | Skilled Nursing Facility | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2006-05-11 |
| 1902404569 | Shenandoah Heights Healthcare LLC | Skilled Nursing Facility | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2020-10-15 |
| 1215579925 | Morgan Rae Aulenbach | Physical Therapist | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2019-10-14 |
| 1033665930 | Logan J. Zeitler | Occupational Therapist | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2016-08-30 |
| 1124484241 | Ridgeview Operations LLC | Skilled Nursing Facility | 200 Pennsylvania Ave, Shenandoah, PA 17976-1332 | 2016-01-05 |
| Find all providers in zip 17976 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518417690 | Eric E. Petterson P.C. | Internal Medicine | 1 S Main St, Shenandoah, PA 17976 | 2016-10-12 |
| 1245787530 | Eric E. Petterson P.C. | Internal Medicine | 1 S Main St, Shenandoah, PA 17976-2332 | 2016-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053957613 | Global Health and Recovery Services LLC | Internal Medicine | 3229 Kensington Ave, Philadelphia, PA 19134-1934 | 2019-11-19 |
| 1952946253 | Kaitlyn Renee Mackey | Internal Medicine | 33 Rollins Ln, Willow Street, PA 17584-8606 | 2019-11-10 |
| 1184177263 | Cleanslate Medical Group of Pennsylvania LLC | Internal Medicine | 100 N Wilkes Barre Blvd Ste 103, Wilkes Barre, PA 18702-5240 | 2016-07-26 |
| 1831559814 | Roxanne Rick | Internal Medicine | 2501 Mckeever St, Monongahela, PA 15063-4549 | 2016-03-03 |
| 1770960882 | Medically Assisted Recovery Services Inc | Internal Medicine | 10802 Bustleton Ave, Philadelphia, PA 19116-3302 | 2015-04-28 |
| 1013301985 | Karen Sees | Internal Medicine | 1266 Lindholm Road, Kane, PA 16735 | 2015-03-27 |
| 1144473208 | Christopher Jackson Davis | Internal Medicine | 320 Loucks Rd, Suite 103, York, PA 17404-1752 | 2008-11-02 |
| 1598937245 | James Craig Berman | Internal Medicine | 261 Standish Rd, Merion Station, PA 19066-1133 | 2008-04-01 |
| 1407027725 | Trusandra Elaine Taylor | Internal Medicine | 1745 N 4th St, Philadelphia, PA 19122-3008 | 2008-03-14 |
| 1619081726 | Bernard Amiel Harris | Internal Medicine | 2205 Bridge St, Philadelphia, PA 19137-1313 | 2006-08-18 |
| Find all providers with the same taxonomy | ||||
| City | SHENANDOAH |
| Zip Code | 17976 |
Please comment or provide details below to improve the information on DR. ERIC EVAN PETTERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.