Provider Demographics
NPI:1689689390
Name:RUNGE, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:RUNGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-382-8350
Mailing Address - Fax:518-382-0345
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-382-8350
Practice Address - Fax:518-382-0345
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY098093207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070314000017OtherFIDELIS
NY28N041OtherEMPIRE BC
NY000401694001OtherBSNENY
NY00526201Medicaid
NY11112OtherMVP
NY47353OtherGHI/HMO
NY10002908OtherCDPHP
NY200147OtherSENIOR WHOLE HEALTH
NY4220071OtherAETNA
NY000401694001OtherBSNENY
NY10002908OtherCDPHP