Individual
TIMOTHY C PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 CONSTITUTION DR, STE 217, VA BEACH, VA 23462-6799
(757) 963-1488
Mailing address
860 OMNI BLVD, STE 303, NEWPORT NEWS, VA 23606-4434
(757) 232-8769
(757) 232-8875
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
0101260679
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2011
Last updated
06/30/2016
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