Healthcare Provider Details

I. General information

NPI: 1437141694
Provider Name (Legal Business Name): PETER R MAGGIORE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD SUITE 250
ALBANY NY
12208-1707
US

IV. Provider business mailing address

PO BOX 11471 PETER R MAGGIORE MD PC
ALBANY NY
12211-0471
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-1162
  • Fax:
Mailing address:
  • Phone: 518-444-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER R MAGGIORE
Title or Position: OWNER
Credential: MD
Phone: 518-446-1162