Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD042146L | PA |
Y | 208600000X | Surgeon | MD042146L | PA |
N | 2086S0120X | Pediatric Surgery | MD042146L | PA |
NPI | 1245296292 |
---|---|
Provider Name | Peter W Dillon |
First Address | Hershey, PA 17033-0854 |
Second Address | Hershey, PA 17033-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 07/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012158780002 | (05) | PA |
E27574 | (02) |