MEDICARE: PETER S OH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS006535L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	50077763	OTHER	CAPTIAL BLUE CROSS
3	2035058	OTHER	HIGHMARK/FREEDOM BLUE
4	P009497	OTHER	GATEWAY

General Provider Information

NPI Number	:	1790737666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER S OH DO

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131A OREGON PIKE
Second Line	:
City	:	EPHRATA
State	:	PA
Zip	:	17522-9550
Country	:	US
Telephone Number	:	717-859-1123
Fax Number	:	717-859-2898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/04/2024

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Directions to “ PETER S OH DO” Practice Location

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