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Individual
DR. MICHAEL THEODORE PETERSON
Active
Individual
DR. MICHAEL THEODORE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS-007805L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014151170001
—
PA
01
—
003000
FIRST PRIORITY HEALTH
PA
01
—
02042395
NY MEDICAL ASSISTANCE
NY
01
—
8873
GEISINGER HEALTH PLAN
PA
01
—
PE744170
HIGHMARK BLUE SHIELD
PA
Enumeration date
06/13/2006
Last updated
05/19/2016
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