Provider Demographics
NPI:1073566675
Name:CHIOTELLIS, PHILIP N (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:N
Last Name:CHIOTELLIS
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 1:52 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5206
Mailing Address - Country:US
Mailing Address - Phone:508-771-8804
Mailing Address - Fax:508-790-9453
Practice Address - Street 1:52 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5206
Practice Address - Country:US
Practice Address - Phone:508-771-8804
Practice Address - Fax:508-790-9453
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34683207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110035623/AMedicaid
MAB11452Medicare ID - Type Unspecified
MA110035623/AMedicaid