Healthcare Provider Details

I. General information

NPI: 1023025749
Provider Name (Legal Business Name): TERESA MICHELLE PETERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 POWDER MILL RD
WILMINGTON DE
19803-2907
US

IV. Provider business mailing address

200 POWDER MILL RD
WILMINGTON DE
19803-2907
US

V. Phone/Fax

Practice location:
  • Phone: 302-695-4602
  • Fax: 302-695-1364
Mailing address:
  • Phone: 302-695-4602
  • Fax: 302-695-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA000982
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052054
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC5-0012241
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number25MP00907500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: