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General NPI Number Information
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NPI Number | 1750633582
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Entity Type | Organization
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Legal Business Name | PETER POULOS MD
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 3956 TOWN CENTER BLVD STE 287
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City | ORLANDO
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State | FL
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Zip | 32837-6103
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Country | US
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Telephone | 407-922-0395
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Fax |
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Provider Business Mailing Address
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Address Line | 3956 TOWN CENTER BLVD STE 287
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City | ORLANDO
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State | FL
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Zip | 32837-6103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS ZABEEDA PERSAUD
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Credential |
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Telephone | 407-922-0395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | ME43417
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License Number State | FL
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