Provider Demographics
NPI:1467447763
Name:SOUKAS, PETER ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:SOUKAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:208 COLLYER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1560
Practice Address - Country:US
Practice Address - Phone:401-793-7191
Practice Address - Fax:401-793-7200
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RI13236207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62879Medicare UPIN
F62879Medicare UPIN