Basic Information
| Provider Information | |||||||||
| NPI: | 1356704456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | BENNETT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 ORLEANS ST | ||||||||
| Address2: | THE JOHNS HOPKINS HOSPITAL | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212870010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109557911 | ||||||||
| FaxNumber: | 4109550374 | ||||||||
| Practice Location | |||||||||
| Address1: | 7601 OSLER DR | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212047700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104272574 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2016 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | D87077 | MD | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.