1053555912 NPI number — NADIA VICKI GIANNAKOPOULOS MD PHD

Table of content: NADIA VICKI GIANNAKOPOULOS MD PHD (NPI 1053555912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053555912 NPI number — NADIA VICKI GIANNAKOPOULOS MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIANNAKOPOULOS
Provider First Name:
NADIA
Provider Middle Name:
VICKI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053555912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10655 59 STREET NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMONTON
Provider Business Mailing Address State Name:
AB
Provider Business Mailing Address Postal Code:
T6A2K5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
780-466-7073
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF ALBERTA HOSPITAL
Provider Second Line Business Practice Location Address:
8440 112 STREET NW
Provider Business Practice Location Address City Name:
EDMONTON
Provider Business Practice Location Address State Name:
AB
Provider Business Practice Location Address Postal Code:
T6G 2B7
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
780-407-8822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  ML60095933 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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