Provider Demographics
NPI:1912904806
Name:ANASTASSIOU, PETER THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:THOMAS
Last Name:ANASTASSIOU
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 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-600-7860
Mailing Address - Fax:415-600-7865
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:STE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-600-7860
Practice Address - Fax:415-600-7865
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43203208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00014566OtherRAILROAD MEDICARE
CA00A432030Medicaid
CA00A432030OtherBLUE SHIELD OF CALIFORNIA
CA00A432031Medicare PIN
CAP00014566OtherRAILROAD MEDICARE
CAF34531Medicare UPIN