Provider Demographics
NPI:1184696841
Name:PELTON, WILLIAM N (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:N
Last Name:PELTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:164 BOYNTON AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1241
Mailing Address - Country:US
Mailing Address - Phone:518-561-1122
Mailing Address - Fax:518-562-3476
Practice Address - Street 1:164 BOYNTON AVE
Practice Address - Street 2:STE 103
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1241
Practice Address - Country:US
Practice Address - Phone:518-561-1122
Practice Address - Fax:518-562-3476
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2019-09-13
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Provider Licenses
StateLicense IDTaxonomies
NY19375401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01561233Medicaid
NYBB3661Medicare ID - Type Unspecified
NY01561233Medicaid