Basic Information
| Provider Information | |||||||||
| NPI: | 1679770382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELSER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69030 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212649030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732306 | ||||||||
| Practice Location | |||||||||
| Address1: | 6161 KEMPSVILLE CIR STE 250 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579654890 | ||||||||
| FaxNumber: | 7579654893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 04/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305203010 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 192967 | 01 | VA | BCBS (PHYSICAL THERAPY) | OTHER | 9748355 | 01 | VA | AETNA | OTHER | 247660 | 01 | VA | BCBS (PHYSICAL THERAPY) | OTHER | 1679770382 | 05 | VA | MEDICAID | P00709407 | 01 | VA | RAILROAD MEDICARE | OTHER |