Provider Demographics
NPI:1487651568
Name:KATSAROS, CONSTANTINE (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:
Last Name:KATSAROS
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 1:401 MARKET ST
Mailing Address - Street 2:STE 1000
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2893
Mailing Address - Country:US
Mailing Address - Phone:740-284-1775
Mailing Address - Fax:740-284-1754
Practice Address - Street 1:705 N 4TH ST
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1813
Practice Address - Country:US
Practice Address - Phone:740-282-2852
Practice Address - Fax:740-282-4740
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033898K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHO212531Medicaid
OHKA0368337Medicare ID - Type Unspecified
C00917Medicare UPIN