Healthcare Provider Details

I. General information

NPI: 1427494624
Provider Name (Legal Business Name): CHRISTOS COLOVOS MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401
US

IV. Provider business mailing address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA120275
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number042.0014143
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: