Provider Demographics
NPI:1134309990
Name:LITCHFIELD, PETER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:LITCHFIELD
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 1:1019 W OAKLAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2357
Mailing Address - Country:US
Mailing Address - Phone:423-915-5000
Mailing Address - Fax:423-915-5045
Practice Address - Street 1:1019 W OAKLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2357
Practice Address - Country:US
Practice Address - Phone:423-915-5000
Practice Address - Fax:423-915-5045
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30027208D00000X
TN45503208D00000X
NC2013-00015208D00000X
GA065367207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516619Medicaid
VA1134309990Medicaid
VA1134309990Medicaid