Provider Demographics
NPI:1518982701
Name:POUTSIAKA, DEBRA D (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:D
Last Name:POUTSIAKA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WASHINGTON ST
Mailing Address - Street 2:TUFTS-NEW ENGLAND MEDICAL CENTER, BOX 041
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-7005
Mailing Address - Fax:617-636-8525
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:TUFTS-NEW ENGLAND MEDICAL CENTER, BOX 041
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-7005
Practice Address - Fax:617-636-8525
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76031207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1213288OtherMASSHEALTH
MA1213288OtherMASSHEALTH