Provider Demographics
NPI:1437148145
Name:FLESSAS, ATHANASIOS P (MD)
Entity Type:Individual
Prefix:
First Name:ATHANASIOS
Middle Name:P
Last Name:FLESSAS
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 1:830 OAK ST
Mailing Address - Street 2:SUITE 105W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1168
Mailing Address - Country:US
Mailing Address - Phone:508-897-4721
Mailing Address - Fax:508-897-4771
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:SUITE 105 W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1168
Practice Address - Country:US
Practice Address - Phone:508-897-4721
Practice Address - Fax:508-897-4771
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0133221Medicaid
MAM08269Medicare ID - Type Unspecified
MA0133221Medicaid