Provider Demographics
NPI:1144419227
Name:PETERSON, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 VARNUM ST NE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2151
Mailing Address - Country:US
Mailing Address - Phone:202-526-2509
Mailing Address - Fax:202-529-7215
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE #101
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-526-2509
Practice Address - Fax:202-529-7215
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD124712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCGO1726Medicare PIN