Provider Demographics
NPI:1194781930
Name:DWYER, PEGGY (NP ADULT HEALTH)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:NP ADULT HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:ST. PETER'S HEALTH PARTNERS PAYER CREDENTIALING
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:147 HOOSICK ST
Practice Address - Street 2:SETON SPECIALTY SERVICES
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2393
Practice Address - Country:US
Practice Address - Phone:518-268-5380
Practice Address - Fax:518-268-5801
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH045554-23363LA2200X
NYF300527-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP01011573OtherRAILROAD MEDICARE
NH30340278Medicaid
NH30340278Medicaid
NHNP167302Medicare PIN