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Anne K. Petersen

Family Medicine

Allopathic & Osteopathic Physicians

632 Broadway Ph, New York, NY 10012-2614

PECOS Enrollment

This provider is enrolled in PECOS as ANNE PETERSEN.

Based on the most recent information from CMS, provider Anne K. Petersen is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1043398613
Provider Type
Individual
Full Name
Petersen, Anne K.
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
11/1/2006
Last Updated
2/5/2025

Contact Information

Practice Location

632 Broadway Ph, New York, NY 10012-2614

(800) 731-4254

Unlisted Fax

Mailing Location

4309 Omni Pl, Raleigh, NC 27613-1584

(412) 310-0638

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 2014-00719 North Carolina
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License A94402 California

Provider Identifiers

ID	Description	Issuer
ID 00A944020	Description Medicaid	Issuer Unlisted California

Anne K. Petersen

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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