Healthcare Provider Details

I. General information

NPI: 1801586631
Provider Name (Legal Business Name): STEPHANOS VASSILOPOULOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2696
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3906
  • Fax: 617-726-7653
Mailing address:
  • Phone: 617-726-3906
  • Fax: 617-726-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number3019979
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: