Healthcare Provider Details

I. General information

NPI: 1689231458
Provider Name (Legal Business Name): BRIDGET ALEXANDRA PETERS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY MEDICINE RESIDENCY 129 N WASHINGTON STREET
SUMTER SC
29150
US

IV. Provider business mailing address

900 FOULK RD STE 200
WILMINGTON DE
19803-3155
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-9755
  • Fax: 803-774-9494
Mailing address:
  • Phone: 302-655-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0024046
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL82147
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: