Provider Demographics
NPI:1063405298
Name:HUGHES, PETER M (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:HUGHES
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 1:830 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4099
Mailing Address - Country:US
Mailing Address - Phone:315-785-4000
Mailing Address - Fax:
Practice Address - Street 1:22567 SUMMIT DR BLDG 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7210
Practice Address - Country:US
Practice Address - Phone:315-782-7230
Practice Address - Fax:315-779-2032
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2025-10-16
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
NY1439595208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPH051E3610OtherEBS
NY24122OtherMVP
10000929OtherCDPHP
NY00972963Medicaid
NY000405963001OtherBS
NY00972963Medicaid
NYBA0477Medicare PIN