Provider Demographics
NPI:1861566002
Name:PETROTOS, ATHANASSIOS (MD)
Entity type:Individual
Prefix:DR
First Name:ATHANASSIOS
Middle Name:
Last Name:PETROTOS
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:C/O GREENWICH HOSPITAL
Mailing Address - Street 2:5 PERRYRIDGE RD., STE. 3-2200
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4608
Mailing Address - Country:US
Mailing Address - Phone:203-863-4300
Mailing Address - Fax:203-863-4310
Practice Address - Street 1:77 LAFAYETTE PL
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-5426
Practice Address - Country:US
Practice Address - Phone:203-863-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043286208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH63136Medicare UPIN