MEDICARE: SPIRITHOULA D VASILOPOULOS MD

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	0101263622	VA

General Provider Information

NPI Number	:	1952389397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPIRITHOULA D VASILOPOULOS MD

Provider Business Mailing Address
First Line	:	611 S CARLIN SPRINGS RD
Second Line	:	STE 301
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1086
Country	:	US
Telephone Number	:	731-423-8697
Fax Number	:	731-422-5743

Provider Business Practice Location Address
First Line	:	700 W FOREST AVE
Second Line	:	STE 300
City	:	JACKSON
State	:	TN
Zip	:	38301-3937
Country	:	US
Telephone Number	:	731-422-0239
Fax Number	:	731-422-0223

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	12/13/2017

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