Provider Demographics
NPI:1629163779
Name:ANGELOPOULOS, PETER (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ANGELOPOULOS
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19227 PALMDALE CT
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-9619
Mailing Address - Country:US
Mailing Address - Phone:516-967-6261
Mailing Address - Fax:
Practice Address - Street 1:19227 PALMDALE CT
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-9619
Practice Address - Country:US
Practice Address - Phone:516-967-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182538207RC0000X
FLA524-660-61-062-0207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2185632Medicaid
LAP01080737OtherRR MEDICARE
LA2185632Medicaid
LA4R058F942Medicare PIN