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Organization

PETER POULOS MD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS ZABEEDA PERSAUD (OFFICE MANAGER)
(407) 922-0395
Entity
Organization

Contact information

Practice address
3956 TOWN CENTER BLVD, STE 287, ORLANDO, FL 32837-6103
(407) 922-0395
Mailing address
3956 TOWN CENTER BLVD, STE 287, ORLANDO, FL 32837-6103

Taxonomy

Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
ME43417
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
064304100
FL
01
260038681
RAILROAD MEDICARE
Enumeration date
10/03/2012
Last updated
10/03/2012
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