Provider Demographics
NPI:1841221041
Name:PETERS, MICHAEL B JR (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:PETERS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:537 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2146
Mailing Address - Country:US
Mailing Address - Phone:302-892-9900
Mailing Address - Fax:302-892-9980
Practice Address - Street 1:537 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2146
Practice Address - Country:US
Practice Address - Phone:302-892-9900
Practice Address - Fax:302-892-9980
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEDE-C1-0007290208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE014305C53Medicare PIN
DE014305YEVDMedicare PIN