Provider Demographics
NPI: | 1306828520 |
---|---|
Name: | ROBOTIS, DIONYSSIOS A (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | DIONYSSIOS |
Middle Name: | A |
Last Name: | ROBOTIS |
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: | PO BOX 415348 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02241-5348 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-225-8885 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 50 MEMORIAL DR |
Practice Address - Street 2: | |
Practice Address - City: | LEOMINSTER |
Practice Address - State: | MA |
Practice Address - Zip Code: | 01453-2238 |
Practice Address - Country: | US |
Practice Address - Phone: | 978-466-2052 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-11-15 |
Last Update Date: | 2023-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 213608 | 207RC0001X, 207RC0000X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 0164381 | Medicaid | |
MA | A3353501 | Medicare PIN | |
MA | G98729 | Medicare UPIN |