Provider Demographics
NPI:1174674709
Name:VLAHOS, PETER THEODORE
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:THEODORE
Last Name:VLAHOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 FISHINGER ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2114
Mailing Address - Country:US
Mailing Address - Phone:614-451-7033
Mailing Address - Fax:
Practice Address - Street 1:1570 FISHINGER ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2114
Practice Address - Country:US
Practice Address - Phone:614-451-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001234213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9076753Medicaid
OHVL0011203Medicare ID - Type Unspecified
OH9076753Medicaid