Provider Demographics
NPI:1679241061
Name:NGUYEN, STEVEN PETER (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PETER
Last Name:NGUYEN
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 1:4077 WEST RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1637
Mailing Address - Country:US
Mailing Address - Phone:607-753-9977
Mailing Address - Fax:570-887-6864
Practice Address - Street 1:4077 WEST RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1637
Practice Address - Country:US
Practice Address - Phone:607-753-9977
Practice Address - Fax:570-887-6864
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT224532207Q00000X
NY331820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine