DR. KEVIN EDWARD PELTIER I (NPI# 1407823792) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407823792 |
| Entity Type | Individual |
| Full Name | DR. KEVIN EDWARD PELTIER I |
| Credential | MD |
| Practice Address |
8644 Sudley Rd Suite 308 Manassas VA 20110-4400 |
| Mailing Address |
8644 Sudley Rd. Suite 308 Manassas VA 20110 |
| Practice Telephone | 7033699070 |
| Practice Fax Number | 7033699240 |
| Mailing Telephone | 7033699070 |
| Enumeration Date | 2006-03-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
0101239534 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA HMO | 2357733 | 01 | |
| AETNA | 7957069 | 01 | |
| ANTHEM | 176914 | 01 |
| Street Address |
8644 SUDLEY RD SUITE 308 |
| City | MANASSAS |
| State | VA |
| Zip Code | 20110-4400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093719536 | Sassan Hassassian | Anesthesiology | 8644 Sudley Rd, Ste 117, Manassas, VA 20110-4417 | 2005-06-13 |
| 1861906661 | Robbie Lynnel Neal | Nurse Practitioner | 8644 Sudley Rd, Manassas, VA 20110 | 2017-12-01 |
| 1386053502 | Nmg Affiliate Practice I LLC | Psychiatry & Neurology | 8644 Sudley Rd, Suite 315, Manassas, VA 20110-4417 | 2014-08-13 |
| 1568720225 | Physical Medicine Associates, Ltd | Physical Medicine & Rehabilitation | 8644 Sudley Rd, Suite 117, Manassas, VA 20110-4417 | 2012-05-01 |
| 1649583717 | Nadia M Ghieth | Physical Therapist | 8644 Sudley Rd, Suite 308, Manassas, VA 20110-4417 | 2010-07-19 |
| 1801035548 | Prosperity Prince William Rx Inc | Pharmacy | 8644 Sudley Rd, Suite 120, Manassas, VA 20110-4417 | 2009-02-19 |
| 1144466798 | Anna-marie E. Hammond | Physical Therapist | 8644 Sudley Rd, Suite 310, Manassas, VA 20110-4417 | 2009-01-05 |
| 1619127982 | Vinod B Patel | Pharmacist | 8644 Sudley Rd, Suite 120, Manassas, VA 20110-4417 | 2008-09-23 |
| 1457513848 | Uyenphuong Ho Le | Internal Medicine | 8644 Sudley Rd, Suite 118, Manassas, VA 20110-4417 | 2008-06-27 |
| 1316151632 | Nicole Dirienzo | Psychiatry & Neurology | 8644 Sudley Rd, Suite 315, Manassas, VA 20110-4417 | 2007-05-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184246787 | Sini Eapen | Nurse Practitioner | 9380 Forestwood Lane, 9380 Unit B, Manassas, VA 20110 | 2020-05-18 |
| 1023662202 | United Health Home Care Agency | Registered Nurse | 8789 Commerce Ct#202, Manassas, VA 20110 | 2019-07-26 |
| 1750868097 | Elaine K. Sours, D.d.s., P.C. | Dentist | 8719 Plantation Lane, Manassas, VA 20110 | 2018-07-19 |
| 1962904573 | Donielle Francis | Specialist/Technologist | 10420 Monterosa Pl, Manassas, VA 20110 | 2018-02-28 |
| 1003332354 | Katrina Kask | Occupational Therapist | 6985 Centreville Rd., Manassas, VA 20110 | 2017-08-18 |
| 1477091478 | Mega Health Services, Inc | General Practice | 9602 Champion Ct, Manassas, VA 20110 | 2017-02-09 |
| 1811340599 | Malik Usman Dds, PC | Dentist | 8559 Sudley Road, Manassas, VA 20110 | 2016-07-19 |
| 1871944660 | Chitra Subbaraj | Physical Therapist | 8595 Centreville Rd, Manassas, VA 20110 | 2016-06-23 |
| 1093186512 | Daczkowski Orthodontics | Dentist | 8715 Stonewall Road, Manassas, VA 20110 | 2015-10-09 |
| 1851770366 | Candace Fleming | Counselor | 9242b Mosby St, Manassas, VA 20110 | 2015-05-29 |
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| Taxonomy Code | 207XX0005X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Sports Medicine |
| An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, training and fitness, athletic performance and the impact of dietary supplements, pharmaceuticals, and nutrition on performance and health, coordination of care within the team setting utilizing other health care professionals, field evaluation and management, soft tissue biomechanics and injury healing and repair. Knowledge and understanding of the principles and techniques of rehabilitation, athletic equipment and orthotic devices enables the specialist to prevent and manage athletic injuries. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton changed, source changed] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. ACGME Accredited Program Requirements: 1 year GME in the specialty + 5 years of Orthopaedic Surgery for a total of 6 years |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417178310 | Bradford Knight | Orthopaedic Surgery | 8525 Rolling Rd, Suite 300, Manassas, VA 20110-3647 | 2007-05-01 |
| 1639132681 | John Jungkyum Kim | Orthopaedic Surgery | 8644 Sudley Rd Ste 308, Manassas, VA 20110-4425 | 2006-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831751148 | Sideline Orthopedics and Sports Medicine, LLC | Orthopaedic Surgery | 125 Akers Farm Rd Ste C&d, Christiansburg, VA 24073-4866 | 2019-07-08 |
| 1881171718 | Franklin Clinic Corp | Orthopaedic Surgery | 210 Fairview Dr Ste A, Franklin, VA 23851-1216 | 2018-07-24 |
| 1932638921 | Sideline Orthopedics and Sports Medicine, LLC | Orthopaedic Surgery | 1787 W. Lee Hwy, Forest Medical Park, Unit B, Bldg 2, Wytheville, VA 24382-1437 | 2017-06-05 |
| 1477956878 | Virginia Commonwealth University | Orthopaedic Surgery | 821 W Franklin St, Richmond, VA 23284-9012 | 2014-09-30 |
| 1871920132 | Mark T Wolfe | Orthopaedic Surgery | 3906 Breezeport Way, Apt 105, Suffolk, VA 23435-1080 | 2013-10-02 |
| 1750724167 | Ryan Austin Harrell | Orthopaedic Surgery | 5818 Harbour View Blvd Ste 150d, Suffolk, VA 23435-3327 | 2013-04-16 |
| 1306088687 | Nathan William Coleman | Orthopaedic Surgery | 13350 Franklin Farm Rd Ste 220, Herndon, VA 20171-4095 | 2009-04-01 |
| 1497923288 | Ryan Glenn Miyamoto | Orthopaedic Surgery | 3620 Joseph Siewick Dr Ste 201, Fairfax, VA 22033-1758 | 2008-02-14 |
| 1467662791 | Stephen F. Brockmeier | Orthopaedic Surgery | 515 Ray C Hunt Dr Ste 1100, Charlottesville, VA 22903-2981 | 2007-05-23 |
| 1386706620 | David R. Diduch | Orthopaedic Surgery | 515 Ray C. Hunt Dr, Charlottesville, VA 22903-2981 | 2006-12-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.