Provider Demographics
NPI:1679581300
Name:METRAKOS, PETER PANAGIOTIS (MD, FRCSC, FACS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PANAGIOTIS
Last Name:METRAKOS
Suffix:
Gender:M
Credentials:MD, FRCSC, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MUHS - RVH SITE
Mailing Address - Street 2:S10.26, 687 AVENUE DES PINS O
Mailing Address - City:MONTREAL
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H3A 1A1
Mailing Address - Country:CA
Mailing Address - Phone:514-843-1600
Mailing Address - Fax:
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:UHC CAMPUS, RENAL/TRANSPLANT - 4TH FL
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-4548
Practice Address - Fax:802-847-3619
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010480204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02425390Medicaid
VT1009964Medicaid
VTVN3453Medicare ID - Type Unspecified
NY02425390Medicaid