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NPI Code Detail

MEDICARE: STACY PETERSON D.O.

MEDICARE: STACY PETERSON D.O.
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
1207P00000XEmergency Medicine Physician34007398OH

General Provider Information

NPI Number : 1952416489
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY PETERSON D.O.
Provider Business Mailing Address
First Line : 4 BOXWOOD LN
Second Line :
City : BEVERLY
State : MA
Zip : 01915-1365
Country : US
Telephone Number : 401-829-7256
Fax Number : 978-774-3400
Provider Business Practice Location Address
First Line : 1997 MIAMISBURG CENTERVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45459-3811
Country : US
Telephone Number : 800-514-1494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 01/01/2022

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