Healthcare Provider Details

I. General information

NPI: 1881683761
Provider Name (Legal Business Name): PETER STEPHEN MIELE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW
WASHINGTON DC
20016-4382
US

IV. Provider business mailing address

4201 CATHEDRAL AVE NW
WASHINGTON DC
20016-4979
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-7400
  • Fax: 202-244-9645
Mailing address:
  • Phone: 202-244-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD33225
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0058142
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: