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General NPI Number Information
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NPI Number | 1477260701
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Entity Type | Individual
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Provider Name | PIETER R REPPENHAGEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 16 PELHAM RD STE 1
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City | SALEM
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State | NH
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Zip | 03079-3077
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Country | US
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Telephone | 978-794-1946
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Fax |
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Provider Business Mailing Address
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Address Line | 575 TURNPIKE ST STE 11
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-5937
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Country | US
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Telephone | 978-794-1946
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2075
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License Number State | NH
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