Healthcare Provider Details

I. General information

NPI: 1699845388
Provider Name (Legal Business Name): PETER PANOS ZAFIRIDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 REED RD BLDG C-128 CENTRAL OHIO BEHAVIORAL MEDICINE INC
COLUMBUS OH
43220
US

IV. Provider business mailing address

1842 W 5TH AVE
COLUMBUS OH
43212
US

V. Phone/Fax

Practice location:
  • Phone: 614-538-8300
  • Fax: 614-538-1656
Mailing address:
  • Phone: 614-488-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35067456
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: