Individual
KERRY ELIZABETH PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4940 EASTERN AVENUE, BALTIMORE, MD 21264-1508
(410) 550-0100
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6423
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C08311
MD
Other
Enumeration date
10/20/2020
Last updated
11/17/2023
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