Basic Information
| Provider Information | |||||||||
| NPI: | 1851377956 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PRESTIGE PL STE 550 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453426115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377621310 | ||||||||
| FaxNumber: | 9375228493 | ||||||||
| Practice Location | |||||||||
| Address1: | 7740 WASHINGTON VILLAGE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454593953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374334325 | ||||||||
| FaxNumber: | 9374397445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34005030 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000227867 | 01 | OH | ANTHEM | OTHER | 34005030P | 01 | OH | MEDICAL LICENSE | OTHER | D0503007 | 01 | OH | HUMANA/CHOICECARE | OTHER | 000000227867 | 01 | OH | UNICARE | OTHER | D0503006 | 01 | OH | HUMANA/CHOICECARE | OTHER | 160058956 | 01 | OH | RAILROAD MEDICARE | OTHER | 0720366 | 01 | OH | UNITED HEALTH CARE | OTHER | 0976243 | 05 | OH | MEDICAID | 2917001 | 01 | OH | AETNA | OTHER | 421534596078 | 01 | OH | CARESOURCE | OTHER | OC05510 | 01 | OH | NATIONWIDE | OTHER |