Provider Demographics
NPI:1336137116
Name:NAGY, PETER L (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:NAGY
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 1:6115 PEACHTREE DUNWOODY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5684
Mailing Address - Country:US
Mailing Address - Phone:678-837-4022
Mailing Address - Fax:
Practice Address - Street 1:6115 PEACHTREE DUNWOODY RD STE 220
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5684
Practice Address - Country:US
Practice Address - Phone:678-837-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258379-1207SM0001X
CAA62035207SM0001X
IA35596207ZP0007X
NY258379207ZP0007X
GA75849207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36383OtherWELLMARK BCBS
IA0440123Medicaid
IA1440123Medicaid
IA36382OtherWELLMARK BCBS
IA0440123Medicaid
IAI21579Medicare PIN
IA36383OtherWELLMARK BCBS
IAP00295175Medicare PIN