Individual
DR. JOHN CHADWICK PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL VILLAGE DR, SUITE 355, EDGEWOOD, KY 41017-5401
(859) 344-1512
(859) 331-3698
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 344-1512
(859) 331-3698
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
39552
KY
207RI0200X
Infectious Disease Physician
TP802
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64107113
—
KY
Enumeration date
07/11/2005
Last updated
02/26/2026
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