Provider Demographics
NPI:1083600829
Name:OLIVA, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:OLIVA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16 DEGRANDPRE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6451
Mailing Address - Country:US
Mailing Address - Phone:518-563-5000
Mailing Address - Fax:518-563-5099
Practice Address - Street 1:16 DEGRANDPRE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6451
Practice Address - Country:US
Practice Address - Phone:518-563-5000
Practice Address - Fax:518-563-5099
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY205708-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47224Medicare UPIN
NY56655BMedicare ID - Type Unspecified