Provider Demographics
NPI:1720034390
Name:MITSOPOULOS, SPIROS (MD)
Entity Type:Individual
Prefix:
First Name:SPIROS
Middle Name:
Last Name:MITSOPOULOS
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 1:445 CYPRESS ST
Mailing Address - Street 2:UNIT 9
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3600
Mailing Address - Country:US
Mailing Address - Phone:603-663-8230
Mailing Address - Fax:603-663-8239
Practice Address - Street 1:445 CYPRESS ST
Practice Address - Street 2:UNIT 9
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3600
Practice Address - Country:US
Practice Address - Phone:603-663-8230
Practice Address - Fax:603-663-8239
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0102690YPNH01OtherANTHEM
NH0102690YPNH01OtherANTHEM
B86181Medicare UPIN