Basic Information
Provider Information
NPI: 1073803912
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MACARTHUR
FirstName: PETER
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8501 ARLINGTON BLVD
Address2: SUITE 200
City: FAIRFAX
State: VA
PostalCode: 220314617
CountryCode: US
TelephoneNumber: 7039706464
FaxNumber: 7039706465
Practice Location
Address1: 8501 ARLINGTON BLVD
Address2: SUITE 200
City: FAIRFAX
State: VA
PostalCode: 220314617
CountryCode: US
TelephoneNumber: 7039706464
FaxNumber: 7039706465
Other Information
ProviderEnumerationDate: 04/12/2011
LastUpdateDate: 10/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207QS0010X0101255966VAY Allopathic & Osteopathic PhysiciansFamily MedicineSports Medicine

No ID Information.


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