Provider Demographics
NPI:1043499791
Name:KREYMERMAN, PETER A (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:KREYMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 GUARDIAN AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2974
Mailing Address - Country:US
Mailing Address - Phone:252-222-5862
Mailing Address - Fax:252-247-9469
Practice Address - Street 1:3714 GUARDIAN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2974
Practice Address - Country:US
Practice Address - Phone:252-222-5862
Practice Address - Fax:252-247-9469
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC158507208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ342344Medicaid
AZP00624126OtherRAILROAD MEDICARE
AZP00624126OtherRAILROAD MEDICARE