Provider Demographics
NPI:1548487978
Name:HAUGHTON, PETER BRADLEY TATE (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRADLEY TATE
Last Name:HAUGHTON
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 1:1 HAWK DR
Mailing Address - Street 2:SUITE #9, STUDENT HEALTH SERVICE
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2447
Mailing Address - Country:US
Mailing Address - Phone:845-257-3400
Mailing Address - Fax:
Practice Address - Street 1:1 HAWK DR
Practice Address - Street 2:SUITE #9, STUDENT HEALTH SERVICE
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-2447
Practice Address - Country:US
Practice Address - Phone:845-257-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129547208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine