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Contact Information

ERIC E. PETTERSON P.C.
1 S MAIN ST
SHENANDOAH, PA17976
 Phone: 570-861-0802
 Fax: 570-462-1040
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction Medicine

207RA0401X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for ERIC E PETTERSON PC · (Female)

NPI # 1518417690
Status Active
Credentials
Entity Individual
Enumeration date 10/12/2016
Last updated 11/11/2023 - About 3 years ago
Sole proprietor 1 Not specified
Identifiers
  • PA License # MD039636L
  • PA Medicaid 0010036980010
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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