Provider Demographics
NPI:1780871160
Name:PETERSEN, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:533 PARNASSUS AVE RM U-503
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0734
Mailing Address - Country:US
Mailing Address - Phone:415-476-1888
Mailing Address - Fax:415-476-6679
Practice Address - Street 1:533 PARNASSUS AVE RM U-503
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0734
Practice Address - Country:US
Practice Address - Phone:415-476-1888
Practice Address - Fax:415-476-6679
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2024-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA971162080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine