Individual
C GERARD PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 S CEDAR CREST BLVD, SUITE 205, ALLENTOWN, PA 18103-6224
(610) 439-8856
Mailing address
PO BOX 783311, PHILADELPHIA, PA 19178-3311
(484) 884-4500
(484) 884-0699
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD073487L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50059765
CAPITAL BLUE CROSS
PA
Enumeration date
05/11/2006
Last updated
03/22/2016
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