Provider Demographics
NPI:1275512808
Name:MANTZOROS, CHRISTOS SOCRATES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOS
Middle Name:SOCRATES
Last Name:MANTZOROS
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 1:151 COOLODGE AVE
Mailing Address - Street 2:#702
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:617-667-8633
Mailing Address - Fax:617-667-8634
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:ST 816
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-8633
Practice Address - Fax:617-667-8634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77441207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism