Provider Demographics
NPI:1053570531
Name:KOUVATSOS, PETER ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALEXANDER
Last Name:KOUVATSOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-843-8051
Mailing Address - Fax:
Practice Address - Street 1:1777 5TH AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2632
Practice Address - Country:US
Practice Address - Phone:717-843-8051
Practice Address - Fax:717-848-2578
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA179779ES6OtherPTAN