Provider Demographics
NPI:1962588731
Name:GALVIN, PETER ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:GALVIN
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 1:12005 NEWPORT AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-474-5027
Mailing Address - Fax:718-474-4899
Practice Address - Street 1:12005 NEWPORT AVENUE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694
Practice Address - Country:US
Practice Address - Phone:718-474-5027
Practice Address - Fax:718-474-4899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00782485Medicaid
NY81567Medicare ID - Type Unspecified
NY06358GMedicare ID - Type UnspecifiedGROUP
NY00782485Medicaid