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1134192602

NPI Code Detail

MEDICARE: PETER N AULT MD

MEDICARE: PETER N AULT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101029899	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	226152	OTHER	VA	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134192602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER N AULT MD

Provider Business Mailing Address
First Line	:	815 W POYTHRESS ST
Second Line	:
City	:	HOPEWELL
State	:	VA
Zip	:	23860-2532
Country	:	US
Telephone Number	:	804-458-8557
Fax Number	:	804-541-7113

Provider Business Practice Location Address
First Line	:	815 W POYTHRESS ST
Second Line	:
City	:	HOPEWELL
State	:	VA
Zip	:	23860-2532
Country	:	US
Telephone Number	:	804-458-8557
Fax Number	:	804-541-7113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	09/07/2010

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Directions to “ PETER N AULT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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