Provider Demographics
NPI:1649238577
Name:MOURTZINOS, ARTHUR P (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:P
Last Name:MOURTZINOS
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 1:41 MALL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-5481
Mailing Address - Fax:781-744-5429
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-5481
Practice Address - Fax:781-744-5429
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211105208800000X
NH14355208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH110004884AMedicaid
MA2063620Medicaid
MA2063620Medicaid
NH001106401Medicare PIN