Provider Demographics
NPI:1386697365
Name:CONSTANT-PETER, GREGORIE (MD)
Entity type:Individual
Prefix:
First Name:GREGORIE
Middle Name:
Last Name:CONSTANT-PETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11136 BUGENHAGEN DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7032
Mailing Address - Country:US
Mailing Address - Phone:917-670-5908
Mailing Address - Fax:
Practice Address - Street 1:3855 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-8652
Practice Address - Country:US
Practice Address - Phone:407-353-3695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236646207Q00000X
FLME110998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14HP9OtherBCBS
FL004055900Medicaid
NY02711333Medicaid
FLFR443ZMedicare PIN
FL004055900Medicaid
FL14HP9OtherBCBS