Provider Demographics
NPI:1841333432
Name:PETERS, OLIVIA ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:ELLIOTT
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4544
Mailing Address - Country:US
Mailing Address - Phone:808-848-1438
Mailing Address - Fax:
Practice Address - Street 1:23800 JOHN T REID PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2841
Practice Address - Country:US
Practice Address - Phone:256-999-0808
Practice Address - Fax:844-490-5876
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP20413208000000X
NC2008-01630208000000X
HI22410208000000X
AL42070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910714Medicaid