Healthcare Provider Details

I. General information

NPI: 1982942983
Provider Name (Legal Business Name): LOGAN CHRISTOPHER PETERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-1100
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-5095
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone: 301-295-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28128
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: