Provider Demographics
NPI:1073575379
Name:PETERSON, ROBERT T (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:PETERSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2000 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 607
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1001
Mailing Address - Country:US
Mailing Address - Phone:410-266-1644
Mailing Address - Fax:410-266-1642
Practice Address - Street 1:2000 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 607
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-266-1644
Practice Address - Fax:410-266-1642
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-03-05
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Provider Licenses
StateLicense IDTaxonomies
MDD24804207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD77818Medicare UPIN