Provider Demographics
NPI:1427008119
Name:ERHARDT, PETER A (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:ERHARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 E HIGH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1276
Mailing Address - Country:US
Mailing Address - Phone:937-322-8977
Mailing Address - Fax:937-322-5837
Practice Address - Street 1:1835 E HIGH ST STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1276
Practice Address - Country:US
Practice Address - Phone:373-228-9779
Practice Address - Fax:937-322-5837
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041542207R00000X
OH35041542E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00033391OtherMRDICARE RAIL ROAD
000000302748OtherBCBS
OH0524043Medicaid
P00034687OtherRAIL ROAD MEDICARE
OH000000302747OtherANTHEM
000000302748OtherBCBS
OH000000302747OtherANTHEM
P00034687OtherRAIL ROAD MEDICARE