Provider Demographics
NPI:1144268822
Name:VOUKYDIS, PANAGIOTIS CONSTANTINE
Entity type:Individual
Prefix:DR
First Name:PANAGIOTIS
Middle Name:CONSTANTINE
Last Name:VOUKYDIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ABBOTTSFORD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6705
Mailing Address - Country:US
Mailing Address - Phone:617-232-1552
Mailing Address - Fax:617-232-5401
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-868-5350
Practice Address - Fax:617-868-1108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34735207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3264OtherHPHC
MA034735OtherTUFTS HEALTH PLAN
MA2081954Medicaid
MA034735OtherTUFTS HEALTH PLAN
MA2081954Medicaid