Provider Demographics
NPI:1194787473
Name:PARKER, PETER E (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:PARKER
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 1:1970 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3104
Mailing Address - Country:US
Mailing Address - Phone:336-722-1963
Mailing Address - Fax:336-765-5494
Practice Address - Street 1:1900 S HAWTHORNE RD
Practice Address - Street 2:SUITE 480
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3913
Practice Address - Country:US
Practice Address - Phone:336-765-0155
Practice Address - Fax:336-765-0199
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14944208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8965340Medicaid
NC201066AMedicare ID - Type Unspecified
NCC80429Medicare PIN
NC8965340Medicaid