Provider Demographics
NPI:1306821426
Name:CONSTANTINE GEORGIADIS, D.O., P.C.
Entity Type:Organization
Organization Name:CONSTANTINE GEORGIADIS, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GEORGIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-398-2100
Mailing Address - Street 1:6795 E TENNESSEE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1614
Mailing Address - Country:US
Mailing Address - Phone:303-398-2100
Mailing Address - Fax:303-398-2103
Practice Address - Street 1:6795 E TENNESSEE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1614
Practice Address - Country:US
Practice Address - Phone:303-398-2100
Practice Address - Fax:303-398-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51510Medicare UPIN