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General NPI Number Information
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NPI Number | 1174500821
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Entity Type | Individual
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Provider Name | PETER E VONDERAU M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 125 AKERS FARM ROAD SUITE C
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-4867
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Country | US
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Telephone | 540-552-7133
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Fax | 540-251-3516
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Provider Business Mailing Address
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Address Line | P. O. BOX 715868
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City | PHILADELPHIA
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State | PA
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Zip | 19171-5868
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Country | US
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Telephone | 804-215-3063
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Fax | 605-341-4501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 7446
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 7446
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101277437
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License Number State | VA
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