Provider Demographics
NPI:1225037187
Name:DICKINSON, PETER CECIL TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:PETER CECIL
Middle Name:TAYLOR
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-358-1344
Mailing Address - Fax:845-348-8578
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-358-1344
Practice Address - Fax:845-348-8578
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122936207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00815912Medicaid
NY2X4222OtherEMPIRE BC/BS
NY2X4222OtherEMPIRE BC/BS
NY00815912Medicaid