Provider Demographics
NPI:1902892110
Name:KONSTANTAKOS, ANASTASIOS (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIOS
Middle Name:
Last Name:KONSTANTAKOS
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 1:250 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2598
Mailing Address - Country:US
Mailing Address - Phone:603-227-7000
Mailing Address - Fax:
Practice Address - Street 1:246 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2548
Practice Address - Country:US
Practice Address - Phone:603-224-1725
Practice Address - Fax:603-227-7557
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH35007208600000X
MT11339208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT124057900OtherMDCD PIN
MT000097436OtherBCBS PIN
MT011000924Medicare PIN
MT124057900OtherMDCD PIN
MTP00425602Medicare PIN
MT011000925Medicare PIN