MEDICARE: PETER HANNON 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	207R00000X	Internal Medicine Physician	OS007131L	PA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	12826434-1204	UT
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	195753	NY
4	208M00000X	Hospitalist Physician	OS007131L	PA
5	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	OS-007131-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50073483	OTHER	PA	KEYSTONE HEALTH PLAN
2	HA425022	OTHER	PA	HIGHMARK BLUE SHIELD
3	232809429008	OTHER	PA	TRICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	50073483	OTHER	PA	CAPITAL BLUE CROSS
6	1689	OTHER	PA	GEISINGER

General Provider Information

NPI Number	:	1811943335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER HANNON DO

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	1000 EAST MOUNTAIN BLVD
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18711-3478
Country	:	US
Telephone Number	:	570-808-7856
Fax Number	:	570-808-1069

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	06/27/2023

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Directions to “ PETER HANNON DO” Practice Location

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