Organization
PETER POULOS MD
Active
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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