Healthcare Provider Details

I. General information

NPI: 1881671238
Provider Name (Legal Business Name): MICHAEL B PEYSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 WASHINGTON ST
WATERTOWN NY
13601-9371
US

IV. Provider business mailing address

830 WASHINGTON ST
WATERTOWN NY
13601-4034
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-2805
  • Fax: 315-779-5066
Mailing address:
  • Phone: 315-786-7501
  • Fax: 315-779-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101056084
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0101056084
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number217155
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: