Provider Demographics
NPI:1073002150
Name:STATHOPOULOS, JOHNATHAN HARRY (MD)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:HARRY
Last Name:STATHOPOULOS
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 1:101 MANNING DR # 7160
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-3982
Mailing Address - Fax:984-974-9646
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:CB# 7160
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:984-974-3982
Practice Address - Fax:984-974-9646
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC238207390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program