Individual
DR. PETER GLENN WALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 SCOTLAND AVE, CHAMBERSBURG, PA 17201-1452
(717) 263-7788
(717) 263-7609
Mailing address
2000 SCOTLAND AVE, CHAMBERSBURG, PA 17201-1452
(717) 263-7788
(717) 263-7609
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
044-299-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001253180 0002
—
PA
05
—
001253180 0003
—
PA
01
—
01041201
BLUE CROSS
PA
01
—
347968700
DEPT. OF LABOR (WC)
PA
01
—
678804
BLUE SHIELD
PA
01
—
PO00756
CHAMPUS-TRICARE
PA
Enumeration date
09/22/2006
Last updated
12/27/2022
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