Provider Demographics
NPI:1558535351
Name:PETERS, TANIA RAE THERESE (MD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:RAE THERESE
Last Name:PETERS
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 1:5471 C2 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-798-9699
Mailing Address - Fax:
Practice Address - Street 1:5471 C2 WISCONSIN AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-798-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD040173207NS0135X
MDD0073304207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology