Provider Demographics
NPI:1043243777
Name:FOTINOS, PETER C (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:FOTINOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17705 SPRINGWINDS DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7744
Mailing Address - Country:US
Mailing Address - Phone:704-895-3415
Mailing Address - Fax:704-895-3416
Practice Address - Street 1:16511 NORTHCROSS DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5021
Practice Address - Country:US
Practice Address - Phone:704-895-3415
Practice Address - Fax:704-895-3416
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904368Medicaid