MEDICARE: DR. RENE A PETERSON DPM

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	213E00000X	Podiatrist	E10000129	DE

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

General Provider Information

NPI Number	:	1528036142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENE A PETERSON DPM

Provider Business Mailing Address
First Line	:	35202 ATLANTIC AVE
Second Line	:
City	:	MILLVILLE
State	:	DE
Zip	:	19967-6901
Country	:	US
Telephone Number	:	302-541-0323
Fax Number	:	302-539-8736

Provider Business Practice Location Address
First Line	:	35202 ATLANTIC AVE
Second Line	:
City	:	MILLVILLE
State	:	DE
Zip	:	19967
Country	:	US
Telephone Number	:	302-541-0323
Fax Number	:	302-539-8736

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/28/2019

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