Provider Demographics
NPI:1407633654
Name:MARADIANOS, IRINI E
Entity Type:Individual
Prefix:
First Name:IRINI
Middle Name:E
Last Name:MARADIANOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RIVERSIDE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4600
Mailing Address - Country:US
Mailing Address - Phone:781-306-0200
Mailing Address - Fax:781-306-0264
Practice Address - Street 1:75 RIVERSIDE AVE STE 2
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4600
Practice Address - Country:US
Practice Address - Phone:781-306-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant