Healthcare Provider Details

I. General information

NPI: 1356741219
Provider Name (Legal Business Name): VASILIKI KOSTOGIANNES ATS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 10/02/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W FAYETTE ST STE 300
BALTIMORE MD
21201-1756
US

IV. Provider business mailing address

520 W FAYETTE ST STE 300
BALTIMORE MD
21201-1756
US

V. Phone/Fax

Practice location:
  • Phone: 727-267-3986
  • Fax:
Mailing address:
  • Phone: 727-267-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: