Healthcare Provider Details

I. General information

NPI: 1336121581
Provider Name (Legal Business Name): GEORGE KROUMPOUZOS MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 MAIN ST SUITE 320
SOUTH WEYMOUTH MA
02190-1845
US

IV. Provider business mailing address

541 MAIN ST SUITE 320
SOUTH WEYMOUTH MA
02190-1845
US

V. Phone/Fax

Practice location:
  • Phone: 781-812-1078
  • Fax: 781-812-2748
Mailing address:
  • Phone: 781-812-1078
  • Fax: 781-812-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number159743
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD11668
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: