Healthcare Provider Details

I. General information

NPI: 1881634632
Provider Name (Legal Business Name): ARIS D. YANNOPOULOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CROMWELL AVE STE 404
ROCKY HILL CT
06067
US

IV. Provider business mailing address

1111 CROMWELL AVE STE 302
ROCKY HILL CT
06067-3455
US

V. Phone/Fax

Practice location:
  • Phone: 860-525-4469
  • Fax: 860-278-8032
Mailing address:
  • Phone: 860-525-4469
  • Fax: 860-278-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number030012
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number030012
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: