Individual
DR. MANUEL T PERALTA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2103 GRAVES MILL RD, FOREST, VA 24551-2675
(434) 316-7199
(434) 316-6185
Mailing address
2103 GRAVES MILL RD, FOREST, VA 24551-2675
(434) 316-7199
(434) 316-6185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101241169
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014695A65
MEDICARE RAIL ROAD
—
01
—
1245451194
SOUTHERN HEALTH
—
05
—
1245451194
—
VA
01
—
302185
ANTHEM
—
01
—
3700863
CIGNA
—
01
—
541901162
PCHP
—
Enumeration date
05/01/2007
Last updated
05/14/2008
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