1851356513 NPI number — PANAGIOTIS T VLAGOPOULOS M.D.

Table of content: PANAGIOTIS T VLAGOPOULOS M.D. (NPI 1851356513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851356513 NPI number — PANAGIOTIS T VLAGOPOULOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VLAGOPOULOS
Provider First Name:
PANAGIOTIS
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1851356513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 OBERY STREET
Provider Second Line Business Mailing Address:
SUITE 1A
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02360-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-747-4883
Provider Business Mailing Address Fax Number:
508-747-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 OBERY STREET
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02360-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-747-4883
Provider Business Practice Location Address Fax Number:
508-747-6661
Provider Enumeration Date:
04/18/2006

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: 207RN0300X , with the licence number:  207726 , 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: 467109 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9827981 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA11759 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 467109 . This is a "TUFTS MEDICARE PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J28219 . This is a "BLUE SHIELD NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00262951 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 491407 . This is a "US FAMILY HEALTH-PCP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2060710 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3972881 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 467109 . This is a "US FAMILY HEALTH-SPECIALI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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