Healthcare Provider Details

I. General information

NPI: 1861583114
Provider Name (Legal Business Name): IRAKLIS S GEROGIANNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HANOVER ST SUITE 2A
FALL RIVER MA
02720-5444
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-7774
  • Fax: 508-973-7724
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD15652
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number161025
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: