Provider Demographics
NPI:1851377956
Name:PETERSON, CAROLINE E (DO)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8493
Practice Address - Street 1:7756 WASHINGTON VILLAGE DR STE 135
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3999
Practice Address - Country:US
Practice Address - Phone:937-425-4137
Practice Address - Fax:937-425-4139
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720366OtherUNITED HEALTH CARE
OH000000227867OtherUNICARE
OHOC05510OtherNATIONWIDE
OH000000227867OtherANTHEM
OH2917001OtherAETNA
OHD0503006OtherHUMANA/CHOICECARE
OH34005030POtherMEDICAL LICENSE
OH0976243Medicaid
OH160058956OtherRAILROAD MEDICARE
OH421534596078OtherCARESOURCE
OHD0503007OtherHUMANA/CHOICECARE
OH0720366OtherUNITED HEALTH CARE
OH0976243Medicaid