Provider Demographics
NPI:1902859374
Name:MITREV, PETER V (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:V
Last Name:MITREV
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 1:1503 N ROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3243
Mailing Address - Country:US
Mailing Address - Phone:252-335-5446
Mailing Address - Fax:757-461-8238
Practice Address - Street 1:1503 N ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3243
Practice Address - Country:US
Practice Address - Phone:252-335-5446
Practice Address - Fax:252-335-4153
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222101174400000X, 207W00000X, 207WX0009X
NC2005-01046207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology