Provider Demographics
NPI:1629157276
Name:KATSIGIANNIS, ANTONIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIOS
Middle Name:
Last Name:KATSIGIANNIS
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 1:90 MORGAN ST
Mailing Address - Street 2:STE 101-102
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5466
Mailing Address - Country:US
Mailing Address - Phone:203-323-8437
Mailing Address - Fax:203-327-4628
Practice Address - Street 1:90 MORGAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5466
Practice Address - Country:US
Practice Address - Phone:203-323-8437
Practice Address - Fax:203-327-4628
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT035140OtherMEDICAL LICENSE
CTD400000479Medicare PIN
CT035140OtherMEDICAL LICENSE