Provider Demographics
NPI:1659409928
Name:LIACOPULOS, EUGENIA PATRICIA (NP)
Entity Type:Individual
Prefix:MISS
First Name:EUGENIA
Middle Name:PATRICIA
Last Name:LIACOPULOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MASS EYE AND EAR INFIRMARY MEDICAL UNIT
Mailing Address - Street 2:243 CHARLES STREET
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-573-3720
Mailing Address - Fax:617-523-0151
Practice Address - Street 1:243 CHARLES ST
Practice Address - Street 2:MASS EYE AND EAR INFIRMARY MEDICAL UNIT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-3720
Practice Address - Fax:617-523-0151
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3952Medicare ID - Type UnspecifiedMEDICARE NUMBER