Provider Demographics
NPI:1689231458
Name:PETERS, BRIDGET ALEXANDRA (DO)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ALEXANDRA
Last Name:PETERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FOULK RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3155
Mailing Address - Country:US
Mailing Address - Phone:302-655-8868
Mailing Address - Fax:
Practice Address - Street 1:FAMILY MEDICINE RESIDENCY
Practice Address - Street 2:129 N WASHINGTON STREET
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-774-9755
Practice Address - Fax:803-774-9494
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0024046207Q00000X
SCLL82147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine