Healthcare Provider Details

I. General information

NPI: 1780028134
Provider Name (Legal Business Name): RACHEL JENEANNE PETERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL JENEANNE DODGE

II. Dates (important events)

Enumeration Date: 04/28/2013
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BURNET AVE
CINCINNATI OH
45229-3019
US

IV. Provider business mailing address

PO BOX 637764
CINCINNATI OH
45263-7764
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8521
  • Fax: 513-475-7480
Mailing address:
  • Phone: 317-880-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.148198
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01078047
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.148198
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: