MEDICARE: PETER POULOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0805X	Geriatric Psychiatry Physician	ME43417	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260038681	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750633582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER POULOS MD

Provider Business Mailing Address
First Line	:	3956 TOWN CENTER BLVD
Second Line	:	STE 287
City	:	ORLANDO
State	:	FL
Zip	:	32837-6103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3956 TOWN CENTER BLVD
Second Line	:	STE 287
City	:	ORLANDO
State	:	FL
Zip	:	32837-6103
Country	:	US
Telephone Number	:	407-922-0395
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS ZABEEDA PERSAUD
Credential	:
Telephone Number	:	407-922-0395

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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Directions to “PETER POULOS MD ” Practice Location

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