Healthcare Provider Details

I. General information

NPI: 1407834799
Provider Name (Legal Business Name): PETER O KROEMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E STATE ST
ALBION PA
16401-1347
US

IV. Provider business mailing address

155 E STATE ST
ALBION PA
16401-1347
US

V. Phone/Fax

Practice location:
  • Phone: 814-756-4917
  • Fax: 814-756-5226
Mailing address:
  • Phone: 814-756-4917
  • Fax: 814-756-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD027897E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: