Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | D60032 | MD |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 0101273619 | VA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD045745 | DC |
NPI | 1275574519 |
---|---|
Provider Name | Dr. Scott Martin Petersen |
First Address | Washington, DC 20037-3201 |
Second Address | Washington, DC 20037-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
402783300 | (05) | MD |
H86493 | (02) | MD |