Healthcare Provider Details

I. General information

NPI: 1174232144
Provider Name (Legal Business Name): EVA KOTSOPOULOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SILVER ST
WATERVILLE ME
04901-6668
US

IV. Provider business mailing address

22 VINE ST
MELROSE MA
02176-3120
US

V. Phone/Fax

Practice location:
  • Phone: 207-922-3222
  • Fax:
Mailing address:
  • Phone: 774-249-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberCNP221549
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License NumberCNP221549
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: