Provider Demographics
NPI:1083773121
Name:PETERS, ALBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 HAMILTON BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6172
Mailing Address - Country:US
Mailing Address - Phone:484-788-2391
Mailing Address - Fax:610-841-0459
Practice Address - Street 1:2895 HAMILTON BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:484-788-2391
Practice Address - Fax:610-841-0459
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08055600207VE0102X
PAOS005607-L207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF57562Medicare UPIN