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General NPI Number Information
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NPI Number | 1386200780
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Entity Type | Individual
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Provider Name | NICHOLAS TSITSILIANOS MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 281 LINCOLN ST
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City | WORCESTER
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State | MA
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Zip | 01605-2138
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Country | US
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Telephone | 508-334-6606
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Fax | 508-334-9762
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Provider Business Mailing Address
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Address Line | PO BOX 415348
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City | BOSTON
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State | MA
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Zip | 02241-5348
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 1020916
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 1020916
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License Number State | MA
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