Provider Demographics
NPI:1881981975
Name:DEROSA, PETER ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:DEROSA
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 1:2150 PENNSYLVANIA AVENUE, NW
Mailing Address - Street 2:THE GW MEDICAL FACULTY ASSOCIATES
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-741-3000
Mailing Address - Fax:202-741-2185
Practice Address - Street 1:2150 PENNSYLVANIA AVENUE, NW
Practice Address - Street 2:THE GW MEDICAL FACULTY ASSOCIATES
Practice Address - City:WASHINGTON, DC
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-741-3000
Practice Address - Fax:202-741-2185
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD210011850207ZP0101X, 207ZP0102X
MD390200000X
DC390200000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program