Provider Demographics
NPI:1174500953
Name:GERANIOTIS, EVANGELOS G (MD)
Entity Type:Individual
Prefix:DR
First Name:EVANGELOS
Middle Name:G
Last Name:GERANIOTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3127
Mailing Address - Country:US
Mailing Address - Phone:508-771-9550
Mailing Address - Fax:508-790-9304
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3127
Practice Address - Country:US
Practice Address - Phone:508-771-9550
Practice Address - Fax:508-790-9304
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59120208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA795314OtherTUFTS HEALTH PLAN
MA5211954001OtherCIGNA
MA000000029929OtherBMC HEALTHNET
MAJ07274OtherBLUE CROSS BLUE SHIELD
MA3033716Medicaid
MA27124OtherHARVARD PILGRIM HEALTH
MA340004053OtherRAILROAD MEDICARE
MA27124OtherHARVARD PILGRIM HEALTH
A66581Medicare UPIN