Healthcare Provider Details

I. General information

NPI: 1245256569
Provider Name (Legal Business Name): MAUREEN PETERSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BLUE RIDGE RD
RALEIGH NC
27607-0114
US

IV. Provider business mailing address

2801 BLUE RIDGE RD
RALEIGH NC
27607-0114
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-0500
  • Fax:
Mailing address:
  • Phone: 984-974-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2023-03266
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01052766A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: