Provider Demographics
NPI:1407961733
Name:GIALLOURAKIS, COSMAS CHRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:COSMAS
Middle Name:CHRIS
Last Name:GIALLOURAKIS
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 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2026
Mailing Address - Fax:617-724-6832
Practice Address - Street 1:55 FRUIT ST BLK4
Practice Address - Street 2:GASTROENTEROLOGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209147207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA478876OtherTUFTS HEALTH PLAN
MAJ29715OtherBCBS MA
MA2111900Medicaid
I49577Medicare UPIN
MAA39628Medicare ID - Type Unspecified