Provider Demographics
NPI:1558326173
Name:MCQUILLER, PETER SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:SAMUEL
Last Name:MCQUILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4979 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2547
Mailing Address - Country:US
Mailing Address - Phone:716-923-4390
Mailing Address - Fax:716-923-4384
Practice Address - Street 1:6970 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9591
Practice Address - Country:US
Practice Address - Phone:716-947-9147
Practice Address - Fax:716-947-5175
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY237775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02848768Medicaid
NY02848768Medicaid