Provider Demographics
NPI:1952368615
Name:PSARRAS, PETER JOHN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:PSARRAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:PSARRAS CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:GR 20 VIA 15
Mailing Address - Street 2:VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-752-0081
Mailing Address - Fax:
Practice Address - Street 1:100 AVE LAUREL
Practice Address - Street 2:HOSPITAL REGIONAL BAYAMON SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-787-5151
Practice Address - Fax:787-787-5151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
89112PSOtherSSS
600088OtherMMM
PE3571OtherPAN AMERICAN LIFE
5014OtherNUMBER ESPECIALIDAD
7000006778OtherELECTRONIC MEDIA CLAIM
204264OtherUTI PREFERRED HEALTH PLAN
32735OtherASOCIACION MAESTROS PR
3378OtherAMERICAN HEALTH INC
PR89112PSOtherTRIPLES
060673OtherCRUZ AZUL
9560073OtherHUMANA
9560073OtherHUMANA
060673OtherCRUZ AZUL
204264OtherUTI PREFERRED HEALTH PLAN