Provider Demographics
NPI:1790944114
Name:KINGHAM, T PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:T
Middle Name:PETER
Last Name:KINGHAM
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 1:52 SAINT MARKS PL
Mailing Address - Street 2:APT. 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8103
Mailing Address - Country:US
Mailing Address - Phone:817-886-4045
Mailing Address - Fax:
Practice Address - Street 1:52 SAINT MARKS PL
Practice Address - Street 2:APT. 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8103
Practice Address - Country:US
Practice Address - Phone:817-886-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2289082086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology