Provider Demographics
NPI:1386686137
Name:PETERS, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:104 WOODMONT BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-386-2300
Mailing Address - Fax:615-386-2399
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-297-2700
Practice Address - Fax:615-386-2399
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-05-07
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Provider Licenses
StateLicense IDTaxonomies
TN21581207RP1001X
TN0215812080P0214X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN164099509OtherUNITED HEALTHCARE
TN2092886OtherCIGNA
TN4018883OtherBLUE CROSS OF TN
TNTN0190OtherAMERICHOICE-TENNCARE ONLY
TN10077103OtherAMERIGROUP-TNCARE AND MCR ADVANTAGE
TN5557149OtherAETNA
TN1508914Medicaid
TN1100342185OtherUSA PPO-GEHA
TN12255039OtherMULTIPLAN/PHCS
TN849925OtherUSA-MCO
TN290013797OtherMEDICARE RR
KY64920762Medicaid
KY64920762Medicaid
TN103I299233Medicare PIN