Provider Demographics
NPI:1932137122
Name:PETERS, NANCY J (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1616 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1433
Mailing Address - Country:US
Mailing Address - Phone:716-835-3097
Mailing Address - Fax:716-837-4654
Practice Address - Street 1:1616 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1433
Practice Address - Country:US
Practice Address - Phone:716-835-3097
Practice Address - Fax:716-837-4654
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01357060Medicaid
NYE15528Medicare UPIN
NYG26307Medicare ID - Type Unspecified