Provider Demographics
NPI:1235209172
Name:GERGEN, PETER JOSEPH (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSEPH
Last Name:GERGEN
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RM 3067 6610 ROCKLEDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-6610
Mailing Address - Country:US
Mailing Address - Phone:301-451-3233
Mailing Address - Fax:301-480-1566
Practice Address - Street 1:6610 ROCKLEDGE DR
Practice Address - Street 2:RM 3067
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-6610
Practice Address - Country:US
Practice Address - Phone:301-451-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033331208000000X
WI22082-020208000000X
DCMD18708208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0365694Medicaid
015058L01Medicare ID - Type Unspecified
DC0365694Medicaid