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General NPI Number Information
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NPI Number | 1427494624
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Entity Type | Individual
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Provider Name | CHRISTOS COLOVOS MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 111 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401
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Country | US
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Telephone | 802-847-3790
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A120275
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 042.0014143
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License Number State | VT
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