Provider Demographics
NPI:1427053263
Name:VAN TRIGT, PETER III (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:VAN TRIGT
Suffix:III
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 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-3200
Mailing Address - Fax:336-832-3201
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-832-3200
Practice Address - Fax:336-832-3201
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24547208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1802304OtherUHC
NC8984782Medicaid
NC84782OtherBCBS
NC61687OtherMEDCOST
NC330003706OtherRR MCR
NCE11656Medicare UPIN
NC211135DMedicare PIN