Healthcare Provider Details

I. General information

NPI: 1912904806
Provider Name (Legal Business Name): PETER THOMAS ANASTASSIOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 200
SAN FRANCISCO CA
94115-2373
US

IV. Provider business mailing address

2100 WEBSTER ST SUITE 200
SAN FRANCISCO CA
94115-2373
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-7860
  • Fax: 415-600-7865
Mailing address:
  • Phone: 415-600-7860
  • Fax: 415-600-7865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA43203
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA43203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: