# ERIC E. PETTERSON P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518417690
- **Authorized official:** DR. ERIC EVAN PETTERSON MD (PRESIDENT)
- **Authorized official phone:** (570) 462-1040

## Contact information

- **Practice address:** 1 S MAIN ST, SHENANDOAH, PA 17976
- **Practice address phone:** (570) 861-0802
- **Practice address fax:** (570) 462-1040
- **Mailing address:** 1 S MAIN ST, SHENANDOAH, PA 17976-2332
- **Mailing address phone:** (570) 861-0802
- **Mailing address fax:** (570) 462-1040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | MD039636L | PA | Yes |

## Other

- **Enumeration date:** 10/12/2016
- **Last updated:** 11/11/2023