Provider Demographics
NPI:1821053174
Name:PETERSON, WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W COMMERCIAL ST
Mailing Address - Street 2:LORD FAIRFAX HEALTH DISTRICT
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4828
Mailing Address - Country:US
Mailing Address - Phone:540-722-3470
Mailing Address - Fax:540-722-3475
Practice Address - Street 1:150 W COMMERCIAL ST
Practice Address - Street 2:LORD FAIRFAX HEALTH DISTRICT
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4828
Practice Address - Country:US
Practice Address - Phone:540-722-3470
Practice Address - Fax:540-722-3475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010233752083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine