Doctor Name: | KOSTANTINOS PANTELIS POULIKIDIS |
NPI Number: | 1689018830 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | AS2383278 - 0842 |
Business Practice Address: | 30 Shelburne Rd Stamford Hospital, Department Of Surgery Stamford, CT - 069023628 |
Business Phone Number: | 2032767467 |
Business Fax Number: | 2032767020 |
Mailing Address: | Po Box 9317, 30 Shelburne Road, Department Of Surgery STAMFORD |
State: | CT |
Postal Code: | 06904 |
Phone Number: | 2032767467 |
Fax Number: | 2032767020 |
NPI Enumeration Date: | 04/18/2013 |
NPI Last Update Date: | 09/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | AS2383278 - 0842 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |