Healthcare Provider Details

I. General information

NPI: 1437235645
Provider Name (Legal Business Name): CONSTANTINE GEORGE SCORDALAKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD SUITE 2300
NEWBURGH IN
47630-8940
US

IV. Provider business mailing address

4199 GATEWAY BLVD SUITE 2300
NEWBURGH IN
47630-8940
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-4610
  • Fax: 812-858-4611
Mailing address:
  • Phone: 812-858-4610
  • Fax: 812-858-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number01067031A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01067031A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: