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 1:526 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2232
Mailing Address - Country:US
Mailing Address - Phone:518-792-5340
Mailing Address - Fax:518-792-5908
Practice Address - Street 1:526 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2232
Practice Address - Country:US
Practice Address - Phone:518-792-5340
Practice Address - Fax:518-792-5908
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-02-20
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
10000929OtherCDPHP
NY00972963Medicaid
NY24122OtherMVP
NYPH051E3610OtherEBS
NY000405963001OtherBS
NY00972963Medicaid
NYBA0477Medicare PIN