Provider Demographics
NPI:1457421380
Name:PETER J PANAGOTACOS, MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PETER J PANAGOTACOS, MD A MEDICAL CORPORATION
Other - Org Name:DERMATOLOGY CENTER OF SAN FRANCISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PANAGOTACOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-922-3344
Mailing Address - Street 1:2001 UNION STREET
Mailing Address - Street 2:SUITE #520
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4110
Mailing Address - Country:US
Mailing Address - Phone:415-922-3344
Mailing Address - Fax:415-921-7759
Practice Address - Street 1:2001 UNION STREET
Practice Address - Street 2:SUITE #520
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4110
Practice Address - Country:US
Practice Address - Phone:415-922-3344
Practice Address - Fax:415-921-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ53573ZOtherANTHEM
CAZZZ53573ZOtherANTHEM