Provider Demographics
NPI:1306019328
Name:PETERSON, EMILY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 RADNOR RD
Mailing Address - Street 2:STE 101
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7986
Mailing Address - Country:US
Mailing Address - Phone:814-231-7878
Mailing Address - Fax:814-237-1034
Practice Address - Street 1:100 RADNOR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7986
Practice Address - Country:US
Practice Address - Phone:814-231-7878
Practice Address - Fax:814-237-1034
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2020-02-04
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Provider Licenses
StateLicense IDTaxonomies
PAMD429105208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery