Provider Demographics
NPI:1699729541
Name:PETERSON, RHONDA LYNN (MD)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 SENECA ROAD NORTH
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1931
Mailing Address - Country:US
Mailing Address - Phone:607-385-3700
Mailing Address - Fax:607-385-3160
Practice Address - Street 1:49 CENTER ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1931
Practice Address - Country:US
Practice Address - Phone:607-281-1970
Practice Address - Fax:607-281-1969
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165191207Q00000X
NY165191-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005119501OtherB/C WNY
NY080044473OtherMEDICARE RAILROAD
NY01423629Medicaid
NY102500BFOtherPREFERRED CARE
NY05119501OtherCOMMUNITY BLUE
NY40851001OtherUNIVERA
NY4630259OtherAETNA
NY005119501OtherB/C WNY
NYJ400278085Medicare PIN
NYF54960Medicare UPIN