Individual
PETER D ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 LAWRENCE RD, SUITE 201, BROOMALL, PA 19008-3301
(610) 492-5900
(610) 492-5903
Mailing address
30 LAWRENCE RD, SUITE 201, BROOMALL, PA 19008-3301
(610) 492-5900
(610) 492-5903
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD059272L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0651758000
IBC
PA
01
—
2512918
AETNA HMO
PA
01
—
779455
BLUE SHIELD
PA
01
—
7910189
AETNA TRADITIONAL
PA
Enumeration date
06/28/2006
Last updated
02/06/2018
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