Provider Demographics
NPI:1083644132
Name:MASTROGIANNIS, DIMITRIOS S (MD,PHD,FACOG)
Entity Type:Individual
Prefix:MR
First Name:DIMITRIOS
Middle Name:S
Last Name:MASTROGIANNIS
Suffix:
Gender:M
Credentials:MD,PHD,FACOG
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Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:90 PRESIDENTIAL PLAZA
Practice Address - Street 2:3RD FL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-464-4458
Practice Address - Fax:315-464-6388
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY181866207V00000X, 2080N0001X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.136742Medicaid
NY01464295Medicaid
NY01464295Medicaid