Provider Demographics
NPI:1538105788
Name:PAPPAS, DEMETRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMETRA
Middle Name:
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:FEGAN 10, CHILDREN'S HOSPITAL BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7025
Mailing Address - Fax:617-730-0252
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:FEGAN 10, CHILDREN'S HOSPITAL BOSTON
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7025
Practice Address - Fax:617-730-0252
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA90455208000000X
MA2337692080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053510Medicaid
CAGR0053510Medicaid