Provider Demographics
NPI:1174549968
Name:TAKACS, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:TAKACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7979
Mailing Address - Fax:757-446-8907
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7979
Practice Address - Fax:757-446-8907
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055079207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1174549968Medicaid
VA1174549968Medicaid
NC1174549968Medicaid
VA1174549968Medicaid
VAP01229398Medicare PIN