Provider Demographics
NPI:1699713495
Name:PETERSON, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:PETERSON
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:317 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1344
Practice Address - Country:US
Practice Address - Phone:717-786-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014323E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006850290003OtherRR MEDICARE
PA0006850290003Medicaid
PA30027962OtherKEYSTONE MERCY
PA000000127269OtherUNISON
PA000000127269OtherGATEWAY
PA0038488000OtherINDEPENDENCE BLUE CROSS
PA0555758OtherAETNA-HMO
PA100364DOtherMERCY
PA5898345OtherAETNA-NON HMO
PA7376572OtherCIGNA
PA50055854OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA000142601OtherHIGHMARK
PA35903OtherGEISINGER
PA100364DOtherMERCY
PA0006850290003Medicaid