Healthcare Provider Details

I. General information

NPI: 1255604906
Provider Name (Legal Business Name): AVRAAM PLOUMIS MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST # STR-33A MGH/ORTHO DEPT/SPINE SERVICE
BOSTON MA
02114-2621
US

IV. Provider business mailing address

19 LINDEN ST
BROOKLINE MA
02445-7859
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-3932
  • Fax:
Mailing address:
  • Phone: 617-643-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17325
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: