Basic Information
| Provider Information | |||||||||
| NPI: | 1376938043 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | ERIC | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71690 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232551690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042852300 | ||||||||
| FaxNumber: | 8042882850 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 E MARKET ST | ||||||||
| Address2: | SUMMA HEALTH SYSTEM/ORTHOPAEDIC SURGERY RESIDENCY | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303794138 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 06/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0101268214 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 57.026651 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.