Provider Demographics
NPI:1447202270
Name:PETERSON, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:PETERSON
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 1:7 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4401
Mailing Address - Country:US
Mailing Address - Phone:609-265-3975
Mailing Address - Fax:
Practice Address - Street 1:1001 BRIGGS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4100
Practice Address - Country:US
Practice Address - Phone:856-866-7466
Practice Address - Fax:856-866-9088
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48986207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5102201Medicaid
NJE44392Medicare UPIN
NJ604613CMBMedicare ID - Type Unspecified