Healthcare Provider Details

I. General information

NPI: 1043398613
Provider Name (Legal Business Name): ANNE K. PETERSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BROADWAY PH
NEW YORK NY
10012-2614
US

IV. Provider business mailing address

4309 OMNI PL
RALEIGH NC
27613-1584
US

V. Phone/Fax

Practice location:
  • Phone: 800-731-4254
  • Fax:
Mailing address:
  • Phone: 412-310-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA94402
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-00719
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: