Provider Demographics
NPI:1679765630
Name:DINELI, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DINELI, A PROFESSIONAL CORPORATION
Other - Org Name:DINA A. ELIOPOULOS, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELIOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-275-9440
Mailing Address - Street 1:9 NORTH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2755
Mailing Address - Country:US
Mailing Address - Phone:978-275-9440
Mailing Address - Fax:978-275-9470
Practice Address - Street 1:9 NORTH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2755
Practice Address - Country:US
Practice Address - Phone:978-275-9440
Practice Address - Fax:978-275-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203898208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9722360Medicaid