Active NPI
Ila M Peterson, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Wynnewood, PA
National Provider Identifier
1497734685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- MD070185L
- Practice address
- 100 E Lancaster Ave
Wynnewood, PA 19096-3450 - Phone
- (610) 645-8013
- NPI assigned
- Jan 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | MD070185L | PA | Primary |
Addresses
Primary practice location
100 E Lancaster Ave
Wynnewood, PA 19096-3450
Mailing address
100 E Lancaster Ave
Wynnewood, PA 19096-3450
Phone (610) 645-8013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD070185L | PA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271289600000",
"number": "1497734685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E LANCASTER AVE",
"city": "WYNNEWOOD",
"state": "PA",
"postal_code": "190963450",
"telephone_number": "610-645-8013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E LANCASTER AVE",
"city": "WYNNEWOOD",
"state": "PA",
"postal_code": "190963450",
"telephone_number": "610-645-8013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "ILA",
"middle_name": "M",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-16",
"last_updated": "2010-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "PA",
"license": "MD070185L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wynnewood, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.