Healthcare Provider Details

I. General information

NPI: 1558365593
Provider Name (Legal Business Name): WALTER C PEPPELMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SIR THOMAS CT
HARRISBURG PA
17109-4839
US

IV. Provider business mailing address

820 SIR THOMAS CT
HARRISBURG PA
17109-4839
US

V. Phone/Fax

Practice location:
  • Phone: 717-652-9555
  • Fax: 717-657-9023
Mailing address:
  • Phone: 717-652-9555
  • Fax: 717-791-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOS005888L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS005888L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: