Provider Demographics
NPI:1245243609
Name:ROUVELAS, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ROUVELAS
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 1:8115 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2804
Mailing Address - Country:US
Mailing Address - Phone:718-833-5303
Mailing Address - Fax:718-833-5304
Practice Address - Street 1:8115 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2804
Practice Address - Country:US
Practice Address - Phone:718-833-5303
Practice Address - Fax:718-833-5304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193878-1207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623541Medicaid
NY161188OtherELDERPLAN
NY7969061OtherAETNA/USHC PPO/POS
NY102998OtherAETNA/USHC (PCP ONLY)
NY132698122OtherU. HEALTHCARE
NY1P0045OtherTOUCHSTONE
NY2325878OtherAETNA/USHC HMO INTERN.MED
NY2327011OtherAETNA/USHC HMO CARDIOLOGY
NYP1931221OtherOXFORD
NYRP3878OtherATLANTIS
NY00000093064OtherBETTER HEALTH PPO
NY1P0045OtherPHS
NY7817826005OtherCIGNA
NY11N8621OtherNEIGHBORHOOD
NY35285OtherMASTERCARE
NY901308102OtherAMERI HEALTH
NY17J031OtherBC/BS
NY202049OtherUSF HP
NY01623541Medicaid