Provider Demographics
NPI:1477637932
Name:PEET, THERESA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARY
Last Name:PEET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9515 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3124
Mailing Address - Country:US
Mailing Address - Phone:410-663-3200
Mailing Address - Fax:410-663-5977
Practice Address - Street 1:9515 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3124
Practice Address - Country:US
Practice Address - Phone:410-663-3200
Practice Address - Fax:410-663-5977
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG154472Medicare UPIN
MDMD445RMedicare ID - Type Unspecified