Healthcare Provider Details

I. General information

NPI: 1780692541
Provider Name (Legal Business Name): KALLIOPI PETROPOULOU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-7029
  • Fax: 315-464-7056
Mailing address:
  • Phone: 315-464-7029
  • Fax: 315-464-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD418887
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number276263-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: