Provider Demographics
NPI:1851377956
Name:PETERSON, CAROLINE E (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:E
Last Name:PETERSON
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 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8493
Practice Address - Street 1:7740 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3953
Practice Address - Country:US
Practice Address - Phone:937-433-4325
Practice Address - Fax:937-439-7445
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000227867OtherANTHEM
OH34005030POtherMEDICAL LICENSE
OHD0503007OtherHUMANA/CHOICECARE
OH000000227867OtherUNICARE
OHD0503006OtherHUMANA/CHOICECARE
OH160058956OtherRAILROAD MEDICARE
OH0720366OtherUNITED HEALTH CARE
OH0976243Medicaid
OH2917001OtherAETNA
OH421534596078OtherCARESOURCE
OHOC05510OtherNATIONWIDE
OH0720366OtherUNITED HEALTH CARE
OH0976243Medicaid