1427008119 NPI number — PETER A ERHARDT MD

Table of content: PETER A ERHARDT MD (NPI 1427008119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427008119 NPI number — PETER A ERHARDT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERHARDT
Provider First Name:
PETER
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427008119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1835 E HIGH ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45505-1276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-322-8977
Provider Business Mailing Address Fax Number:
937-322-5837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1835 E HIGH ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
373-228-9779
Provider Business Practice Location Address Fax Number:
937-322-5837
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35041542 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 35041542E , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00033391 . This is a "MRDICARE RAIL ROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000302748 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0524043 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00034687 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000302747 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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