Provider Demographics
NPI:1326047291
Name:KECHEJIAN, PETER A (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:KECHEJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:994 WEST JERICHO TURNPIKE
Mailing Address - Street 2:STE. 104
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3211
Mailing Address - Country:US
Mailing Address - Phone:631-543-1440
Mailing Address - Fax:631-543-1930
Practice Address - Street 1:994 WEST JERICHO TURNPIKE
Practice Address - Street 2:STE. 104
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3211
Practice Address - Country:US
Practice Address - Phone:631-543-1440
Practice Address - Fax:631-543-1930
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197100208VP0000X, 208VP0014X, 207L00000X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01521140Medicaid
NYF71043Medicare UPIN
NY05785JMedicare ID - Type UnspecifiedGHI MEDICARE
NY01521140Medicaid