Individual
DR. PETER ROGER GENERELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5766 THOMAS JEFFERSON PKWY, PALMYRA, VA 22963-4383
(434) 591-1314
(434) 591-1317
Mailing address
5766 THOMAS JEFFERSON PKWY, PALMYRA, VA 22963-4383
(434) 591-1314
(434) 591-1317
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0101037702
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005854440
—
VA
01
—
2714080002
SOUTHERN HEALTH
VA
01
—
440083
ANTHEM BCBS
VA
Enumeration date
05/22/2006
Last updated
11/17/2009
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