Provider Demographics
NPI:1285934760
Name:PETERSMEYER, NANCY QUAYLE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:QUAYLE
Last Name:PETERSMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S 23RD ST UNIT 7I
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 S 23RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3016
Practice Address - Country:US
Practice Address - Phone:267-678-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2022-08-09
Deactivation Date:2022-07-05
Deactivation Code:
Reactivation Date:2022-08-09
Provider Licenses
StateLicense IDTaxonomies
PAMD043782L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry