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General NPI Number Information
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NPI Number | 1235209172
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Entity Type | Individual
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Provider Name | PETER JOSEPH GERGEN M.D.,M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 6610 ROCKLEDGE DR RM 3067
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City | BETHESDA
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State | MD
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Zip | 20892-6610
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Country | US
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Telephone | 301-451-3233
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Fax |
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Provider Business Mailing Address
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Address Line | RM 3067 6610 ROCKLEDGE DRIVE
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City | BETHESDA
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State | MD
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Zip | 20892-6610
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Country | US
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Telephone | 301-451-3233
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Fax | 301-480-1566
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0033331
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 22082-020
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD18708
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License Number State | DC
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