Provider Demographics
NPI:1144436940
Name:PETERSON, POWERS (MD)
Entity type:Individual
Prefix:DR
First Name:POWERS
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LEXINGTON AVE
Mailing Address - Street 2:SUITE 670
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:646-962-4950
Mailing Address - Fax:646-962-4960
Practice Address - Street 1:575 LEXINGTON AVE
Practice Address - Street 2:SUITE 670
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6102
Practice Address - Country:US
Practice Address - Phone:646-962-4950
Practice Address - Fax:646-962-4960
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130733207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12080Medicare UPIN