Healthcare Provider Details

I. General information

NPI: 1194415927
Provider Name (Legal Business Name): ATHANASIOS 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

60 FENWOOD RD
BOSTON MA
02115-6128
US

IV. Provider business mailing address

60 FENWOOD RD
BOSTON MA
02115-6128
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax: 617-732-5766
Mailing address:
  • Phone: 617-732-5500
  • Fax: 617-732-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number3021648
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: