Active NPI
Nancy Lynn Petersilge, M.D.
- Dermatology Physician
- Los Altos, CA
National Provider Identifier
1467609396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- G44365
- Practice address
- 1529 Arbor Ave
Los Altos, CA 94024-5914 - Phone
- (650) 941-0890
- NPI assigned
- Aug 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | G44365 | CA | Primary |
Addresses
Primary practice location
1529 Arbor Ave
Los Altos, CA 94024-5914
Mailing address
1529 Arbor Ave
Los Altos, CA 94024-5914
Phone (650) 941-0890
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G44365 | Other | CA | CALIFORNIA DEPARTMENT CONSUMER AFFAIRS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G44365 | CA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219276800000",
"number": "1467609396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1529 ARBOR AVE",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940245914",
"telephone_number": "650-941-0890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1529 ARBOR AVE",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940245914",
"telephone_number": "650-941-0890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSILGE",
"first_name": "NANCY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-21",
"last_updated": "2008-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "G44365",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA DEPARTMENT CONSUMER AFFAIRS",
"identifier": "G44365",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Altos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.