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Individual

COURTNEY SLOCUM PETERSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
750 WASHINGTON ST # 178, TUFTS MEDICAL CENTER, BOSTON, MA 02111-1526
(617) 636-8200
(617) 636-7587
Mailing address
57 E CONCORD ST, APT 3, BOSTON, MA 02118-1996
(770) 519-8108

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
004199
GA
363A00000X
Physician Assistant
Primary
2624
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000867701
MEDICARE
Enumeration date
06/20/2005
Last updated
01/14/2016
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