1851377956 NPI number — DR. CAROLINE E PETERSON DO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851377956 NPI number — DR. CAROLINE E PETERSON DO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PETERSON

Provider First Name:

CAROLINE

Provider Middle Name:

E

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

DO

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1851377956

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/13/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 PRESTIGE PL STE 550

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MIAMISBURG

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

45342-6115

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

937-762-1310

Provider Business Mailing Address Fax Number:

937-522-8493

Provider First Line Business Practice Location Address:

7756 WASHINGTON VILLAGE DR STE 135

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CENTERVILLE

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

45459-3999

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

937-425-4137

Provider Business Practice Location Address Fax Number:

937-425-4139

Provider Enumeration Date:

12/20/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  34005030 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0720366 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000227867 . This is a "UNICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: OC05510 . This is a "NATIONWIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000227867 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 2917001 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: D0503006 . This is a "HUMANA/CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 34005030P . This is a "MEDICAL LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0976243 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 160058956 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 421534596078 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: D0503007 . This is a "HUMANA/CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".