Provider Demographics
NPI:1568789477
Name:PETERS, TATSIANA (MD)
Entity Type:Individual
Prefix:
First Name:TATSIANA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4804
Mailing Address - Country:US
Mailing Address - Phone:302-734-2500
Mailing Address - Fax:302-734-7758
Practice Address - Street 1:1342 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4804
Practice Address - Country:US
Practice Address - Phone:302-734-2500
Practice Address - Fax:302-734-7758
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10010593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine