Provider Demographics
NPI:1023389418
Name:DELAPORTAS, GRIGORIOS (PA)
Entity Type:Individual
Prefix:MR
First Name:GRIGORIOS
Middle Name:
Last Name:DELAPORTAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5345
Mailing Address - Country:US
Mailing Address - Phone:813-431-2600
Mailing Address - Fax:
Practice Address - Street 1:192 TILLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4440
Practice Address - Country:US
Practice Address - Phone:802-847-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant