Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 0420010480 | VT |
NPI | 1679581300 |
---|---|
Provider Name | Dr. Peter Panagiotis Metrakos |
First Address | Montreal, QUEBEC H3A 1A1 |
Second Address | Burlington, VT 05401-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02425390 | (05) | NY |
1009964 | (05) | VT |
I12377 | (02) | VT |