Individual
DR. KEVIN EDWARD PELTIER I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8644 SUDLEY RD, SUITE 308, MANASSAS, VA 20110-4400
(703) 369-9070
(703) 369-9240
Mailing address
P. O. BOX 715868, PHILADELPHIA, PA 19171-5868
(804) 215-3063
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101239534
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006401201
—
VA
01
—
176914
ANTHEM
—
01
—
2357733
AETNA HMO
—
01
—
7957069
AETNA
—
Enumeration date
03/05/2006
Last updated
02/24/2023
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