Basic Information
| Provider Information | |||||||||
| NPI: | 1558365593 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEPPELMAN | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3399 TRINDLE RD | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170114407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177615530 | ||||||||
| FaxNumber: | 7177377197 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 SIR THOMAS CT | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171094839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176529555 | ||||||||
| FaxNumber: | 7176579023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | OS005888L | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 0010532880008 | 05 | PA | MEDICAID |