Rene' a Peterson, DPM LLC
Organization Active NPI Podiatrist · Millville, DE
NPI 1003387291 · NPPES record last updated Dec 16, 2018
Key facts
- NPI
- 1003387291
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- RENE' A PETERSON, DPM LLC
- Practice address
- 35202 Atlantic Ave
Millville, DE 19967 - Phone
- (302) 541-0323
- Fax
- (302) 539-8736
- NPI assigned
- Dec 16, 2018
- Organization subpart
- No
Authorized official
- Name
- Rene' Peterson, DPM
- Title
- Owner/Physician
- Phone
- (302) 541-0323
Practitioners 2
-
Rene A Peterson, DPM
-
Christopher S Rush, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190128000409 | DE | Part B Supplier - Clinic/Group Practice | 3173860319 |
Receives reassigned benefits from 1 practitioner Practice locations: Millville, DE |
National Provider Directory
Locations
35715 Atlantic Ave
Unit 3A
Millville, DE 19967
Phone (302) 539-7063
35715 Atlantic Ave
Millville, DE 19967
Phone (302) 258-8868
35202 Atlantic Ave
Millville, DE 19967
Phone (302) 539-7063
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes |
Addresses
Primary practice location
35202 Atlantic Ave
Millville, DE 19967
Mailing address
35202 Atlantic Ave
Millville, DE 19967
Phone (302) 541-0323
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000957915 | Medicaid | DE |
Other names
- Rene' A Peterson DPM
Other providers in Millville, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.