Provider Demographics
NPI:1740209964
Name:RO, PETER SEUNGHWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SEUNGHWAN
Last Name:RO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEUNGHWAN
Other - Middle Name:
Other - Last Name:RO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8001 FRANKLIN FARMS DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5108
Mailing Address - Country:US
Mailing Address - Phone:804-521-5800
Mailing Address - Fax:804-545-4340
Practice Address - Street 1:7611 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-288-4827
Practice Address - Fax:804-288-4494
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046467207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA276256OtherANTHEM/VA HEALTHKEEPERS
VA276279OtherANTHEM/VA HEALTHKEEPERS
VA3152065OtherCIGNA
VA265978OtherMAMSI
VA27413300OtherFEDERAL BLACK LUNG
VA276208OtherANTHEM/VA HEALTHKEEPERS
VA44228OtherSENTARA HEALTH/OPTIMA
VA60043024OtherRAILROAD MEDICARE
VA812876OtherAETNA/US HEALTHCARE HMO
VA107128OtherANTHEM/VA HEALTHKEEPERS
VA4135124OtherAETNA/US HEALTHCARE
VA5802776Medicaid
VA103810OtherANTHEM/VA HEALTHKEEPERS
VA10136181Medicaid
VA276305OtherANTHEM/VA HEALTHKEEPERS
VA276364OtherANTHEM/VA HEALTHKEEPERS
VA69802OtherSOUTHERN HEALTH SERVICES
VA10136181Medicaid
110006779Medicare PIN