Provider Demographics
NPI:1043240674
Name:HOLBROOK, PETER R (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2978
Mailing Address - Country:US
Mailing Address - Phone:202-884-3256
Mailing Address - Fax:202-884-5988
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2978
Practice Address - Country:US
Practice Address - Phone:202-884-3256
Practice Address - Fax:202-884-5988
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD79632080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0174OtherCAREFIRST
VA6727841Medicaid
414687C95Medicare ID - Type Unspecified