=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346504545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVDOKIA ELEFTHERIOU MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2012
-----------------------------------------------------
Last Update Date | 03/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 92 CAMPUS DR STE B
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074-7229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-883-1414
-----------------------------------------------------
Fax | 207-883-1010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92 CAMPUS DR STE B
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074-7229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-883-1414
-----------------------------------------------------
Fax | 207-883-1010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 251878
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | MD21577
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------