Provider Demographics
NPI:1356613376
Name:RAJTAR, PETER P (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:P
Last Name:RAJTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEROY STREET
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676
Mailing Address - Country:US
Mailing Address - Phone:315-265-3300
Mailing Address - Fax:315-261-6025
Practice Address - Street 1:190 OUTER MAIN ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2356
Practice Address - Country:US
Practice Address - Phone:315-265-9271
Practice Address - Fax:315-265-4206
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060453208000000X
NC2014-01669208000000X
NY288880208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics