Basic Information
| Provider Information | |||||||||
| NPI: | 1710129747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8815 GERMANTOWN AVE | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191182722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152488145 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8815 GERMANTOWN AVE | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191182722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152488145 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2009 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A105654 | CA | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | MT196083 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.