Provider Demographics
NPI:1366425902
Name:PETERSON, HEATHER ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANNE
Last Name:PETERSON
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 1:1108 TAMWORTH HILL LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8860
Mailing Address - Country:US
Mailing Address - Phone:919-651-0189
Mailing Address - Fax:
Practice Address - Street 1:97 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8403
Practice Address - Country:US
Practice Address - Phone:919-460-0993
Practice Address - Fax:919-481-3952
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00675208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics