Provider Demographics
NPI:1366573545
Name:KANSAS, PETER G (MD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:G
Last Name:KANSAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24 CENTURY HILL DR
Mailing Address - Street 2:SUITE 001
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2133
Mailing Address - Country:US
Mailing Address - Phone:518-690-2015
Mailing Address - Fax:518-690-0353
Practice Address - Street 1:24 CENTURY HILL DR
Practice Address - Street 2:SUITE 001
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2133
Practice Address - Country:US
Practice Address - Phone:518-690-2015
Practice Address - Fax:518-690-0353
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY092366207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02312527Medicaid
NYB80800Medicare UPIN
NY33616AMedicare ID - Type Unspecified