Healthcare Provider Details

I. General information

NPI: 1205832391
Provider Name (Legal Business Name): CHRIS C. PANAGOULIAS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WATER ST SUITE 101
NASHUA NH
03060-3314
US

IV. Provider business mailing address

17 GRANT LN
OGUNQUIT ME
03907-3647
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-1321
  • Fax: 603-883-1373
Mailing address:
  • Phone: 603-883-1321
  • Fax: 603-883-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberNH123
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: