Healthcare Provider Details

I. General information

NPI: 1265852867
Provider Name (Legal Business Name): NICHOLAS AVGERINOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY HEALTH PRIMARY CARE, BEVERLY 38R ENON STREET
BEVERLY MA
01915
US

IV. Provider business mailing address

LAHEY PROVIDER ENROLLMENT 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-7727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number270791
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: