MEDICARE: DR. DAKOTA ZOEY PETERSON 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	208000000X	Pediatrics Physician	MD485418	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316513773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAKOTA ZOEY PETERSON MD

Provider Business Mailing Address
First Line	:	2540 NEW BUTLER RD STE 200
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-3231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 NEW BUTLER RD STE 200
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-3231
Country	:	US
Telephone Number	:	724-654-2776
Fax Number	:

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	06/10/2024

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