Provider Demographics
NPI:1467898957
Name:PETERS, BART DYLAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:DYLAN
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 51ST ST
Mailing Address - Street 2:APT. 6A
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4466
Mailing Address - Country:US
Mailing Address - Phone:347-609-1871
Mailing Address - Fax:
Practice Address - Street 1:4116 51ST ST
Practice Address - Street 2:APT. 6A
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4466
Practice Address - Country:US
Practice Address - Phone:347-609-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program