Provider Demographics
NPI:1174846372
Name:KAPETANAKIS, THEODOROS (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODOROS
Middle Name:
Last Name:KAPETANAKIS
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 1:1 GENERAL STREET
Mailing Address - Street 2:LAMPREY BUILDING, 4TH FLOOR
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2884
Mailing Address - Country:US
Mailing Address - Phone:978-983-0488
Mailing Address - Fax:978-794-0458
Practice Address - Street 1:1 GENERAL STREET
Practice Address - Street 2:LAMPREY BUILDING, 4TH FLOOR
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2884
Practice Address - Country:US
Practice Address - Phone:978-983-0488
Practice Address - Fax:978-794-0458
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27569207V00000X
WA60406093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology