MEDICARE: MR. ATHANASIOS DESALERMOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	2025041095	MO
2	207RG0100X	Gastroenterology Physician	274317	MA
3	207RG0100X	Gastroenterology Physician	01097413A	IN

General Provider Information

NPI Number	:	1982961066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ATHANASIOS DESALERMOS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3160
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-0803
Country	:	US
Telephone Number	:	978-474-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 MONTGOMERY BLVD NE STE 201
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-1233
Country	:	US
Telephone Number	:	505-727-7833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	03/02/2026

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