Provider Demographics
NPI:1144487968
Name:KOSTARAS, VASILEIOS (MD)
Entity type:Individual
Prefix:DR
First Name:VASILEIOS
Middle Name:
Last Name:KOSTARAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VASILEIOS
Other - Middle Name:
Other - Last Name:KOSTARAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS ROAD
Mailing Address - Street 2:HSC 19
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8191
Mailing Address - Country:US
Mailing Address - Phone:631-444-1791
Mailing Address - Fax:631-444-7689
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:HSC 19
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8191
Practice Address - Country:US
Practice Address - Phone:631-444-1791
Practice Address - Fax:631-444-7689
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191836204F00000X
NY256798390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery