Provider Demographics
NPI:1760417331
Name:TSIRIGOTIS, PAULINE (MD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:TSIRIGOTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1834
Mailing Address - Country:US
Mailing Address - Phone:978-970-1607
Mailing Address - Fax:978-970-1115
Practice Address - Street 1:45 PALMER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1834
Practice Address - Country:US
Practice Address - Phone:978-970-1607
Practice Address - Fax:978-970-1115
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0141020Medicaid
A32749Medicare ID - Type Unspecified
MA0141020Medicaid