Provider Demographics
NPI:1043398613
Name:PETERSEN, ANNE K (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:K
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PORTSMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8699
Mailing Address - Country:US
Mailing Address - Phone:412-310-0638
Mailing Address - Fax:
Practice Address - Street 1:106 PORTSMOUTH CT
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-8699
Practice Address - Country:US
Practice Address - Phone:412-310-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94402207Q00000X
NC2014-00719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A944020Medicaid
CA00A944020Medicaid