Healthcare Provider Details

I. General information

NPI: 1689664583
Provider Name (Legal Business Name): PANAGIOTIS PAPAGEORGIOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE BETH ISRAEL DEACONESS MEDICAL CENTER
BOSTON MA
02215-5400
US

IV. Provider business mailing address

185 PILGRIM RD BAKER-4
BOSTON MA
02215-5324
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-8800
  • Fax: 617-632-7620
Mailing address:
  • Phone: 617-632-9209
  • Fax: 617-632-7620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number76993
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number76993
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: