Organization
ERIC E. PETTERSON P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC EVAN PETTERSON MD (PRESIDENT)
(570) 462-1040
Entity
Organization
Contact information
Practice address
1 S MAIN ST, SHENANDOAH, PA 17976
(570) 861-0802
(570) 462-1040
Mailing address
1 S MAIN ST, SHENANDOAH, PA 17976-2332
(570) 861-0802
(570) 462-1040
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
MD039636L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010036980010
—
PA
Enumeration date
10/12/2016
Last updated
11/11/2023
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