Provider Demographics
NPI:1225154289
Name:PETER AMOS ANKOH MD PA
Entity Type:Organization
Organization Name:PETER AMOS ANKOH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANKOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-728-2999
Mailing Address - Street 1:POST OFFICE BOX 492530
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-2530
Mailing Address - Country:US
Mailing Address - Phone:352-728-2999
Mailing Address - Fax:352-460-0050
Practice Address - Street 1:1107 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6311
Practice Address - Country:US
Practice Address - Phone:352-728-2999
Practice Address - Fax:352-728-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92546207R00000X
FLME 92546261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG0063 RAIL ROADMedicare PIN
FLAD740Medicare PIN