1679581300 NPI number — DR. PETER PANAGIOTIS METRAKOS MD, FRCSC, FACS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679581300 NPI number — DR. PETER PANAGIOTIS METRAKOS MD, FRCSC, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METRAKOS
Provider First Name:
PETER
Provider Middle Name:
PANAGIOTIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FRCSC, FACS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679581300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MUHS - RVH SITE
Provider Second Line Business Mailing Address:
S10.26, 687 AVENUE DES PINS O
Provider Business Mailing Address City Name:
MONTREAL
Provider Business Mailing Address State Name:
QUEBEC
Provider Business Mailing Address Postal Code:
H3A 1A1
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
514-843-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 S PROSPECT ST
Provider Second Line Business Practice Location Address:
UHC CAMPUS, RENAL/TRANSPLANT - 4TH FL
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-4548
Provider Business Practice Location Address Fax Number:
802-847-3619
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204F00000X , with the licence number:  0420010480 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02425390 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009964 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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