Individual
PETER J NEIDENBACH
Active
Individual
PETER J NEIDENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9501356
NC
207N00000X
Dermatology Physician
MMD16384MD
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2214227A
PTAN
NC
01
—
9501356
STATE LICENSE
NC
01
—
MMD16384MD
STATE LICENCE
SC
Enumeration date
05/03/2006
Last updated
12/21/2023
Update your record
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