1447550918 NPI number — GEORGE MOUTSATSOS, MD CARDIOLOGY LLC

Table of content: (NPI 1447550918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447550918 NPI number — GEORGE MOUTSATSOS, MD CARDIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE MOUTSATSOS, MD CARDIOLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1447550918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
904 WESTOVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19807-2981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-983-6908
Provider Business Mailing Address Fax Number:
302-482-3543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3521 SILVERSIDE RD
Provider Second Line Business Practice Location Address:
QUILLEN BUILDING SUITE 2D1
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-983-6908
Provider Business Practice Location Address Fax Number:
302-482-3543
Provider Enumeration Date:
10/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOUTSATSOS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
DEMETRIOS
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
302-540-2743

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  C1-0006169 , 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: 0001091101 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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