MEDICARE: PERICLES M SPYROPOULOS 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	207V00000X	Obstetrics & Gynecology Physician	193132	NY

General Provider Information

NPI Number	:	1609971407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERICLES M SPYROPOULOS M.D.

Provider Business Mailing Address
First Line	:	3715 221ST ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2230
Country	:	US
Telephone Number	:	718-224-7969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2747 CRESCENT ST
Second Line	:	SUITE 104
City	:	ASTORIA
State	:	NY
Zip	:	11102-3142
Country	:	US
Telephone Number	:	718-777-7236
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	12/19/2011

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