1154390995 NPI number — KONSTANTINO A AVRADOPOULOS MD

Table of content: KONSTANTINO A AVRADOPOULOS MD (NPI 1154390995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154390995 NPI number — KONSTANTINO A AVRADOPOULOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVRADOPOULOS
Provider First Name:
KONSTANTINO
Provider Middle Name:
A
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:
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:
1154390995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01550-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-764-6966
Provider Business Mailing Address Fax Number:
508-764-2457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01550-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-764-6966
Provider Business Practice Location Address Fax Number:
508-764-2457
Provider Enumeration Date:
03/15/2006

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: 208600000X , with the licence number:  204941 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8052669 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "HEALTHCARE VALUE MANAGMEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3700043 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45955 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA8132 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22103 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3207048 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 935195 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "ONE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3207048 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45865 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5605292 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A30735 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3207048 . This is a "MEDICAID WELFARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 783988 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22103 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: J22103 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".




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