Provider Demographics
NPI:1558359299
Name:VAN HOUTEN, PETER ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ARTHUR
Last Name:VAN HOUTEN
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 1:2501 STANTONSBURG RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3205
Mailing Address - Country:US
Mailing Address - Phone:252-758-2402
Mailing Address - Fax:252-758-2762
Practice Address - Street 1:2501 STANTONSBURG RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3205
Practice Address - Country:US
Practice Address - Phone:252-758-2402
Practice Address - Fax:252-758-2762
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32591207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC84725OtherBCBS
VA6301011Medicaid
VA085949OtherBCBS
NC7984725Medicaid
NC80015160OtherMEDICARE RAILROAD
C86882Medicare UPIN
NC7984725Medicaid