Provider Demographics
NPI:1144970872
Name:TSOUGRANIS, GEORGE ELEFTHERIOS
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ELEFTHERIOS
Last Name:TSOUGRANIS
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 1:485 COMMON ST UNIT 207
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4472
Mailing Address - Country:US
Mailing Address - Phone:603-812-5347
Mailing Address - Fax:
Practice Address - Street 1:235 WELLESLEY ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1572
Practice Address - Country:US
Practice Address - Phone:781-768-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2354223163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WU0100XNursing Service ProvidersRegistered NurseUrology