Tina A Petersen, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

RS20070349 Issued in NM

Practice address

1 University of New Mexico
Msc10 5590
Albuquerque, NM 87131-0001

Phone

(505) 272-3909

NPI assigned

Apr 19, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283472000000",
    "number": "1184841231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36302",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871766302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY OF NEW MEXICO",
            "address_2": "MSC10 5590",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871310001",
            "telephone_number": "505-272-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "TINA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2010-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "RS20070349",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "MD2010-0502",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAINING",
            "identifier": "RS20070349",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW MEXICO MEDICAL BOARD",
            "identifier": "MD2010-0502",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randal Peters
• Scott T Peters, SLP
• Cynthia Y Petersen, LPCC
• Florence Petersen, CCC/A
• Sharon Denise Petersen, OT
• Cheri Petersin, LMHC
• Abigail Grace Peterson
• Caitlin Peterson
• Cynthia Peterson, PH.D.
• Dana Peterson, MD

• Pediatrics Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Pediatrics Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.