Healthcare Provider Details

I. General information

NPI: 1679581300
Provider Name (Legal Business Name): PETER PANAGIOTIS METRAKOS MD, FRCSC, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST UHC CAMPUS, RENAL/TRANSPLANT - 4TH FL
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

MUHS - RVH SITE S10.26, 687 AVENUE DES PINS O
MONTREAL QUEBEC
H3A 1A1
CA

V. Phone/Fax

Practice location:
  • Phone: 802-847-4548
  • Fax: 802-847-3619
Mailing address:
  • Phone: 514-843-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number0420010480
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: