Individual
JON D PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12007 SUNRISE VALLEY DR, SUITE 120, RESTON, VA 20191-3479
(301) 624-5731
Mailing address
PO BOX 79429, BALTIMORE, MD 21279-0429
(301) 624-5731
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500039
ONITED HEALTHCARE
VA
01
—
1505687000
US DOL WC
DC
01
—
223963
ANTHEM BC BS
VA
01
—
283598
AMERIGROUP
VA
01
—
4054667
AETNA
VA
01
—
45710002
CF DC
DC
01
—
46389
ALLIANCE
VA
01
—
505094
NCPPO
VA
01
—
53508702
CF MD REGIONAL RENDERING
MD
Enumeration date
09/04/2006
Last updated
07/08/2007
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