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General NPI Number Information
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NPI Number | 1639751407
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Entity Type | Individual
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Provider Name | KOSTANTINOS CHRISTOS PAPATHANASIOU
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Gender | Male
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 819 WORCESTER ST
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City | SPRINGFIELD
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State | MA
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Zip | 01151-1045
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Country | US
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Telephone | 337-991-9276
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Fax |
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Provider Business Mailing Address
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Address Line | 276 BURROUGHS RD
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City | BOXBOROUGH
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State | MA
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Zip | 01719-1916
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Country | US
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Telephone | 978-621-1937
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 77572
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1014794
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License Number State | MA
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