Provider Demographics
NPI:1285202226
Name:KONSTANTINIDIS, IPPOKRATIS (MD)
Entity Type:Individual
Prefix:
First Name:IPPOKRATIS
Middle Name:
Last Name:KONSTANTINIDIS
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:UCONN HEALTH-GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:263 FARMINGTON AVENUE. LM068
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1921
Mailing Address - Country:US
Mailing Address - Phone:860-679-2147
Mailing Address - Fax:860-679-4624
Practice Address - Street 1:UCONN HEALTH, INTERNAL MEDICINE ASSOCIATES, OUTPATIENT
Practice Address - Street 2:263 FARMINGTON AVENUE
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-679-4477
Practice Address - Fax:860-679-1025
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program