Provider Demographics
NPI:1184319592
Name:PETERSEN, KIRKLEN ELAINE (MD)
Entity type:Individual
Prefix:
First Name:KIRKLEN
Middle Name:ELAINE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VCUHS GME ADMINISTRATION
Mailing Address - Street 2:PO BOX 980257
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0257
Mailing Address - Country:US
Mailing Address - Phone:804-828-9783
Mailing Address - Fax:
Practice Address - Street 1:VCUHS DEPT OF ANESTHESIOLOGY RESIDENCY
Practice Address - Street 2:417 N. 11TH ST
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0257
Practice Address - Country:US
Practice Address - Phone:804-828-0733
Practice Address - Fax:804-828-8300
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2024-06-25
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Provider Licenses
StateLicense IDTaxonomies
VA0116038403207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology