MEDICARE: DAVID C PETERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD479090	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	25MA12691200	NJ

General Provider Information

NPI Number	:	1043846991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C PETERS MD

Provider Business Mailing Address
First Line	:	4 HARTFORD DR
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07701-4929
Country	:	US
Telephone Number	:	978-587-1651
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 HARTFORD DR STE 1
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07701-4945
Country	:	US
Telephone Number	:	732-741-3600
Fax Number	:	732-741-3603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2020
Last Update Date	:	06/27/2025

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