Basic Information
| Provider Information | |||||||||
| NPI: | 1881981975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEROSA | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 PENNSYLVANIA AVENUE, NW | ||||||||
| Address2: | THE GW MEDICAL FACULTY ASSOCIATES | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027413000 | ||||||||
| FaxNumber: | 2027412185 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 PENNSYLVANIA AVENUE, NW | ||||||||
| Address2: | THE GW MEDICAL FACULTY ASSOCIATES | ||||||||
| City: | WASHINGTON, DC | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027413000 | ||||||||
| FaxNumber: | 2027412185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2011 | ||||||||
| LastUpdateDate: | 07/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | DC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | MD | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.