1497839419 NPI number — IOANNIS KEHAGIAS-ATHANASSOPULOS MD

Table of content: IOANNIS KEHAGIAS-ATHANASSOPULOS MD (NPI 1497839419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497839419 NPI number — IOANNIS KEHAGIAS-ATHANASSOPULOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEHAGIAS-ATHANASSOPULOS
Provider First Name:
IOANNIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEHAGIAS
Provider Other First Name:
IOANNIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497839419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 CARTER DR
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-5854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-378-5494
Provider Business Mailing Address Fax Number:
302-378-1760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 CARTER DR
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-5854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-378-5494
Provider Business Practice Location Address Fax Number:
302-378-1760
Provider Enumeration Date:
10/25/2006

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: 207Q00000X , with the licence number:  C10006722 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 470892742 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2990862 . This is a "AETNA HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2102289 . This is a "MAMSI, ALLIANCE,OPT CHOIC" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1460660 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000021645 . This is a "DPCI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2145623000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 7648389 . This is a "AETNA PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: H77145 . This is a "BCBS DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 080195041 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000021645 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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