Provider Demographics
NPI:1871683334
Name:PETERKIN, RUPERT AUGUSTUS (MD)
Entity Type:Individual
Prefix:DR
First Name:RUPERT
Middle Name:AUGUSTUS
Last Name:PETERKIN
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:P.O. BOX 8748
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE AMALIE
Mailing Address - State:VI
Mailing Address - Zip Code:00801
Mailing Address - Country:US
Mailing Address - Phone:340-777-9696
Mailing Address - Fax:
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:SUITE 206
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-777-9696
Practice Address - Fax:340-715-6441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIF52077Medicare UPIN