Provider Demographics
NPI:1588855514
Name:SIM, PETER ALAN (MD, FACEP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ALAN
Last Name:SIM
Suffix:
Gender:M
Credentials:MD, FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4374 NEW TOWN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2865
Mailing Address - Country:US
Mailing Address - Phone:757-259-1900
Mailing Address - Fax:757-259-1901
Practice Address - Street 1:4374 NEW TOWN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2688
Practice Address - Country:US
Practice Address - Phone:757-259-1900
Practice Address - Fax:757-259-1901
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01068207P00000X
VA0101025382207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588855514Medicaid
VAP00907006OtherRAILROAD MCR
VAA104675Medicare PIN