Provider Demographics
NPI:1770636714
Name:WARRINGTON, PETER R (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:WARRINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3969
Mailing Address - Country:US
Mailing Address - Phone:610-690-4490
Mailing Address - Fax:
Practice Address - Street 1:1260 E WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3969
Practice Address - Country:US
Practice Address - Phone:610-690-4490
Practice Address - Fax:610-328-9391
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004503L207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000730670Medicaid
PA000730670Medicaid
PAB33437Medicare UPIN