Healthcare Provider Details

I. General information

NPI: 1447531678
Provider Name (Legal Business Name): ELISHA E PETERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

28 Q ST NE APT 1
WASHINGTON DC
20002-2474
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4750
  • Fax:
Mailing address:
  • Phone: 773-908-8966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ9475
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberQ9475
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberQ9475
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD046316
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: