Healthcare Provider Details

I. General information

NPI: 1780664292
Provider Name (Legal Business Name): BARBARA LEE PETERLIN II DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY ROAD STE 305
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

205 GRANDVIEW AVENUE SUITE 206
CAMP HILL PA
17011
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3938
  • Fax: 315-464-5359
Mailing address:
  • Phone: 717-745-6223
  • Fax: 717-745-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number339481
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberH70713
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS010064L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: