Petersen, Marta J
Petersen, Marta J is an individual health care provider with primary practice located at 50 N Medical Dr , Salt Lake City UT 84132-1100. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is her primary health care specialty. Petersen, Marta J can be contacted via phone (801) 581-2955.Contact Information
Primary practice address
50 N Medical Dr
Salt Lake City UT 84132-1100
Phone: (801) 581-2955
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | 1664261205 | Utah |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 1664261205 | Utah |
Profile Details
| NPI number | 1972601508 |
|---|---|
| LBN Legal business name | Petersen, Marta J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 20th, 2006 |
| Last updated | Nov 11th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972601508 | NPPES |
| Idaho | MEDICAID | 003054200 | |
| Idaho | MEDICAID | 870468377001 | |
| Idaho | MEDICAID | J0854 | |
| Idaho | MEDICAID | XPY117280 | |
| Idaho | Other | 070004834 | |
| Idaho | MEDICAID | 002089156 |
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