MEDICARE: PANAGIOTIS T VLAGOPOULOS 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	207RN0300X	Nephrology Physician	207726	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	467109	OTHER	MA	TUFTS MEDICARE PREFERRED
5	P00262951	OTHER	MA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	467109	OTHER	MA	TUFTS HEALTH PLAN
2	467109	OTHER	MA	US FAMILY HEALTH-SPECIALI
4	9827981	OTHER		CIGNA
6	3972881	OTHER		AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	491407	OTHER	MA	US FAMILY HEALTH-PCP
9	AA11759	OTHER	MA	HARVARD PILGRIM HEALTH
10	J28219	OTHER	MA	BLUE SHIELD NUMBER

General Provider Information

NPI Number	:	1851356513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PANAGIOTIS T VLAGOPOULOS M.D.

Provider Business Mailing Address
First Line	:	47 OBERY STREET
Second Line	:	SUITE 1A
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2229
Country	:	US
Telephone Number	:	508-747-4883
Fax Number	:	508-747-6661

Provider Business Practice Location Address
First Line	:	47 OBERY STREET
Second Line	:	SUITE 1A
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2229
Country	:	US
Telephone Number	:	508-747-4883
Fax Number	:	508-747-6661

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	06/13/2024

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