Basic Information
| Provider Information | |||||||||
| NPI: | 1356613376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAJTAR | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 LEROY STREET | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152653300 | ||||||||
| FaxNumber: | 3152616025 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 OUTER MAIN ST | ||||||||
| Address2: | |||||||||
| City: | POTSDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136762356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152659271 | ||||||||
| FaxNumber: | 3152654206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2012 | ||||||||
| LastUpdateDate: | 07/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125060453 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2014-01669 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 288880 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.