Provider Demographics
NPI:1497839419
Name:KEHAGIAS-ATHANASSOPULOS, IOANNIS (MD)
Entity Type:Individual
Prefix:
First Name:IOANNIS
Middle Name:
Last Name:KEHAGIAS-ATHANASSOPULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IOANNIS
Other - Middle Name:
Other - Last Name:KEHAGIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:222 CARTER DR
Mailing Address - Street 2:STE 101
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5854
Mailing Address - Country:US
Mailing Address - Phone:302-378-5494
Mailing Address - Fax:302-378-1760
Practice Address - Street 1:222 CARTER DR
Practice Address - Street 2:STE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5854
Practice Address - Country:US
Practice Address - Phone:302-378-5494
Practice Address - Fax:302-378-1760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE470892742OtherCOVENTRY
DE2990862OtherAETNA HMO
DE2102289OtherMAMSI, ALLIANCE,OPT CHOIC
DE1460660OtherAMERIHEALTH PPO
DE1000021645OtherDPCI
DE2145623000OtherAMERIHEALTH HMO
DE7648389OtherAETNA PPO
DEH77145OtherBCBS DE
DE080195041OtherRAILROAD MEDICARE
DE1000021645Medicaid
DE1460660OtherAMERIHEALTH PPO
DE00B470F57Medicare ID - Type UnspecifiedMEDICARE