Individual
MARK PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 GREAT TEAYS BLVD STE 101, SCOTT DEPOT, WV 25560-9548
(304) 757-8803
(304) 757-6904
Mailing address
PO BOX 1680, HUNTINGTON, WV 25717-1680
(304) 781-5159
(304) 523-8115
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
30925
WV
2084P0804X
Child & Adolescent Psychiatry Physician
30925
WV
Other
Enumeration date
05/11/2018
Last updated
05/30/2024
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