Healthcare Provider Details

I. General information

NPI: 1205323201
Provider Name (Legal Business Name): MELANIE ANN PETERS MD, MPH, FACOG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

4909 43RD AVE FL 2
WOODSIDE NY
11377-4453
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2365
  • Fax: 718-270-4122
Mailing address:
  • Phone: 210-215-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number317508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: