Healthcare Provider Details

I. General information

NPI: 1205102555
Provider Name (Legal Business Name): ELENI PATRICIA ASIMACOPOULOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE CHILDREN'S HOSPITAL BOSTON
BOSTON MA
02115
US

IV. Provider business mailing address

9 HAWTHORNE PL APARTMENT 7P
BOSTON MA
02114-2344
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7793
  • Fax:
Mailing address:
  • Phone: 617-417-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208000000X
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: