Petersen, William A

Petersen, William A is an individual health care provider with primary practice located at 10 Century Hill Dr , Latham NY 12110-2162. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Petersen, William A can be contacted via phone (518) 783-5563.

Contact Information

Primary practice address
10 Century Hill Dr Latham NY 12110-2162
Phone: (518) 783-5563
Fax: (518) 785-5708
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 080697 New York

Profile Details

NPI number 1881709079
LBN Legal business name Petersen, William A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881709079 NPPES
New York Other 000401387001 BS OF NENY
New York MEDICAID 00392741 BS OF NENY
New York Other 26208 BS OF NENY
New York Other 10002804 BS OF NENY

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