Provider Demographics
NPI:1669424925
Name:PELTON, STEPHEN L (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:PELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:220 LINDEN OAKS STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2839
Mailing Address - Country:US
Mailing Address - Phone:585-383-4420
Mailing Address - Fax:585-383-4515
Practice Address - Street 1:220 LINDEN OAKS STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2839
Practice Address - Country:US
Practice Address - Phone:585-383-4420
Practice Address - Fax:585-383-4515
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY115901207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000506488005OtherBLUE CROSS BLUE SHIELD
NY102194APOtherPREFERRED CARE PRODUCTS
0140OtherEXCELLUS INDEMNITY PLAN P
NY01684606Medicaid
0308906OtherINDEPENDENT HEALTH PROD
0138OtherEXCELLUS INDEMNITY PLAN P
070009693OtherRAILROAD MEDICARE
5681746OtherAETNA PRODUCTS
040426004286OtherFEDLIS CARE
300340OtherWELL CARE
NYP010115901OtherEXCELLUS MANAGED CARE PRO
NY14162BMedicare ID - Type Unspecified