Provider Demographics
NPI:1336121581
Name:KROUMPOUZOS, GEORGE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:KROUMPOUZOS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1845
Mailing Address - Country:US
Mailing Address - Phone:781-812-1078
Mailing Address - Fax:781-812-2748
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1845
Practice Address - Country:US
Practice Address - Phone:781-812-1078
Practice Address - Fax:781-812-2748
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA159743207N00000X
RIMD11668207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0021305OtherNEIGHBORHOOD HLTH PLAN
MA042297845OtherHCVM
MA310361OtherCIGNA
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MA042297845OtherGREAT WEST HEALTH CARE
MA501224OtherHVD PILGRIM HEALTH CARE
MA64769OtherFALLON
MAJ22231OtherBCBS
MA042297845OtherUNITED HEALTH CARE
MA159743OtherTUFTS
MA042297845OtherTRICARE
MA3209024Medicaid
MA042297845OtherDOC FIRST
MA042297845OtherGIC UNICARE
MA7430154OtherAETNA
MA042297845OtherTRICARE
MA042297845OtherHCVM