Healthcare Provider Details

I. General information

NPI: 1003858515
Provider Name (Legal Business Name): POSEIDON SPYROS VARVITSIOTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR
SANTA FE NM
87505-4728
US

IV. Provider business mailing address

1631 HOSPITAL DR
SANTA FE NM
87505-4728
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-3975
  • Fax: 505-986-8001
Mailing address:
  • Phone: 505-988-3975
  • Fax: 505-986-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number97-397
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number97--397
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: