Healthcare Provider Details

I. General information

NPI: 1174500821
Provider Name (Legal Business Name): PETER E VONDERAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 AKERS FARM ROAD SUITE C
CHRISTIANSBURG VA
24073-4867
US

IV. Provider business mailing address

P. O. BOX 715868
PHILADELPHIA PA
19171-5868
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-7133
  • Fax: 540-251-3516
Mailing address:
  • Phone: 804-215-3063
  • Fax: 605-341-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number7446
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number7446
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101277437
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: