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Individual
DR. PETER ROGER GENERELLY
Active
Individual
DR. PETER ROGER GENERELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0101037702
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005854440
—
VA
01
—
2714080002
SOUTHERN HEALTH
VA
01
—
440083
ANTHEM BCBS
VA
Enumeration date
05/22/2006
Last updated
11/17/2009
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