Provider Demographics
NPI:1477547503
Name:SARKOS, PETER LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:LEWIS
Last Name:SARKOS
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 1:2662 ELM RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410
Mailing Address - Country:US
Mailing Address - Phone:234-244-4251
Mailing Address - Fax:234-244-8218
Practice Address - Street 1:2662 ELM RD
Practice Address - Street 2:BUILDING C
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410
Practice Address - Country:US
Practice Address - Phone:234-244-4251
Practice Address - Fax:234-244-8218
Is Sole Proprietor?:No
Enumeration Date:2005-09-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93650208200000X
OH35083016208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28693OtherBCBS
FL8673211OtherCIGNA
FL273419200Medicaid
FL299019OtherAVMED
FL28693OtherBCBS