Healthcare Provider Details

I. General information

NPI: 1699729541
Provider Name (Legal Business Name): RHONDA LYNN PETERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/21/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CENTER ST
HORNELL NY
14843-1931
US

IV. Provider business mailing address

7309 SENECA ROAD NORTH SUITE 109
HORNELL NY
14843-1931
US

V. Phone/Fax

Practice location:
  • Phone: 607-281-1970
  • Fax: 607-281-1969
Mailing address:
  • Phone: 607-385-3700
  • Fax: 607-385-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number165191
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number165191-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: