Healthcare Provider Details

I. General information

NPI: 1851659916
Provider Name (Legal Business Name): GEORGE SCANGAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZERO EMERSON PLACE SUITE 2D
BOSTON MA
02114
US

IV. Provider business mailing address

ZERO EMERSON PLACE SUITE 2D
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-227-4366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number270252
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: