Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 0101266295 | VA |
NPI | 1003250887 |
---|---|
Provider Name | Dr. William Patrick Petersen JR. |
First Address | Baltimore, MD 21275-5868 |
Second Address | Arlington, VA 22205-3616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 26/10/2020 |