Provider Demographics
NPI:1730159419
Name:ATHANASSIOU, ACHILLES (MD)
Entity type:Individual
Prefix:
First Name:ACHILLES
Middle Name:
Last Name:ATHANASSIOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-4836
Mailing Address - Fax:617-667-2231
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:GRYZMISH 7TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-4836
Practice Address - Fax:617-667-2231
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80677207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA22453Medicare ID - Type Unspecified
MAG45976Medicare UPIN