Healthcare Provider Details

I. General information

NPI: 1265934137
Provider Name (Legal Business Name): STERGIOS ZACHAROULIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HAMLET SQUARE
LONDON UK
NW2 1SR
GB

IV. Provider business mailing address

16 HAMLET SQUARE
LONDON UK
21
GB

V. Phone/Fax

Practice location:
  • Phone: 4-479-4987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number292354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: