Provider Demographics
NPI:1528070398
Name:KIRIAKOPOULOS, ELAINE T (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:T
Last Name:KIRIAKOPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:TINA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:781-275-2570
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-306-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2303692084N0400X, 2084N0400X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology