Provider Demographics
NPI:1144654088
Name:TOWNSEND, PETER KEITH JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:KEITH
Last Name:TOWNSEND
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:LAKE WINOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18625-0489
Mailing Address - Country:US
Mailing Address - Phone:570-378-3047
Mailing Address - Fax:570-378-3418
Practice Address - Street 1:ROUTE 307
Practice Address - Street 2:
Practice Address - City:LAKE WINOLA
Practice Address - State:PA
Practice Address - Zip Code:18625-0489
Practice Address - Country:US
Practice Address - Phone:570-378-3047
Practice Address - Fax:570-378-3418
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA-001763-L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical