MEDICARE: DR. VASILIOS THEODOROS DIAMANTOPOULOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	25MA06113100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184718371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASILIOS THEODOROS DIAMANTOPOULOS M.D.

Provider Business Mailing Address
First Line	:	1018 BOYNTON AVE
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-1692
Country	:	US
Telephone Number	:	908-518-1593
Fax Number	:	973-989-3092

Provider Business Practice Location Address
First Line	:	1018 BOYNTON AVE
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-1692
Country	:	US
Telephone Number	:	908-518-1593
Fax Number	:	973-989-3092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/16/2007

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