Provider Demographics
NPI:1518336015
Name:PETERSON, NORMAN (DVM, PHD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DVM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDIMMUNE WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2204
Mailing Address - Country:US
Mailing Address - Phone:301-398-5112
Mailing Address - Fax:301-398-8112
Practice Address - Street 1:1 MEDIMMUNE WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2204
Practice Address - Country:US
Practice Address - Phone:301-398-5112
Practice Address - Fax:301-398-8112
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6224174MM1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174MM1900XOther Service ProvidersVeterinarianMedical Research