Provider Demographics
NPI:1366892143
Name:BOOR, PETER EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:EDWARD
Last Name:BOOR
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 1:327 N WASHINGTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1535
Mailing Address - Country:US
Mailing Address - Phone:570-961-5522
Mailing Address - Fax:
Practice Address - Street 1:327 N WASHINGTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1535
Practice Address - Country:US
Practice Address - Phone:570-961-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD469603207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology