Healthcare Provider Details

I. General information

NPI: 1144268822
Provider Name (Legal Business Name): DR. PANAGIOTIS CONSTANTINE VOUKYDIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MOUNT AUBURN ST SUITE 303
CAMBRIDGE MA
02138-5600
US

IV. Provider business mailing address

29 ABBOTTSFORD RD
BROOKLINE MA
02446-6705
US

V. Phone/Fax

Practice location:
  • Phone: 617-868-5350
  • Fax: 617-868-1108
Mailing address:
  • Phone: 617-232-1552
  • Fax: 617-232-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34735
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number34735
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: