Peter Poulos MD

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

ME43417 Issued in FL

Legal business name

PETER POULOS MD

Practice address

3956 Town Center Blvd
Ste 287
Orlando, FL 32837-6103

Phone

(407) 922-0395

NPI assigned

Oct 3, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Zabeeda Persaud

Title

Office Manager

Phone

(407) 922-0395

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1750633582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3956 TOWN CENTER BLVD",
            "address_2": "STE 287",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328376103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3956 TOWN CENTER BLVD",
            "address_2": "STE 287",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328376103",
            "telephone_number": "407-922-0395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETER POULOS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-03",
        "last_updated": "2012-10-03",
        "status": "A",
        "authorized_official_last_name": "PERSAUD",
        "authorized_official_first_name": "ZABEEDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "407-922-0395",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "FL",
            "license": "ME43417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "260038681",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064304100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Personal Injury Pain Fix LLC
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• Jana L Perun, ARNP
• Maria Jose Pesantez Lanas
• Peter Pan Day Care Center
• Peter Weissgerber PA
• Anjaly Peter, CRNA
• Colette Peter
• Adam Michael Peterik, DO
• Kira Elana Peterman-Diaz, APRN

• Geriatric Psychiatry Physician in Orlando, FL
• Providers in Orlando, FL by specialty
• Geriatric Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.