Basic Information
| Provider Information | |||||||||
| NPI: | 1669978094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Credential: | NPMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 186 MEDICAL VILLAGE DRIVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | NEWPORT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058559326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023343520 | ||||||||
| FaxNumber: | 8023343512 | ||||||||
| Practice Location | |||||||||
| Address1: | 186 MEDICAL VILLAGE DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058559326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8023343520 | ||||||||
| FaxNumber: | 8023343512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 101-0134136 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.