Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | D09481 | MD |
NPI | 1174614457 |
---|---|
Provider Name | Dr. Ronald Gregory Peterson |
First Address | Baltimore, MD 21263-1568 |
Second Address | Baltimore, MD 21204-6831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 01/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D76565 | (02) | |
KJ43GY/346460-03 | CAREFIRST MARYLAND (01) | MD |
S140/0004 | CAREFIRST REGIONAL (01) | MD |