Provider Demographics
NPI:1952401754
Name:DEXHEIMER, PETER ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROBERT
Last Name:DEXHEIMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3115
Mailing Address - Country:US
Mailing Address - Phone:410-531-6550
Mailing Address - Fax:410-531-6552
Practice Address - Street 1:10840 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3115
Practice Address - Country:US
Practice Address - Phone:410-531-6550
Practice Address - Fax:410-531-6552
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD996QMedicare ID - Type UnspecifiedMEDICARE PROVIDER#
MDT93049Medicare UPIN