Provider Demographics
NPI:1821051277
Name:PAPASTAMELOS, ATHANASIOS G (DO)
Entity Type:Individual
Prefix:DR
First Name:ATHANASIOS
Middle Name:G
Last Name:PAPASTAMELOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:PAPASTAMELOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2106 NEW RD STE F1
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1053
Mailing Address - Country:US
Mailing Address - Phone:609-926-5451
Mailing Address - Fax:609-926-1372
Practice Address - Street 1:2106 NEW RD STE F1
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1053
Practice Address - Country:US
Practice Address - Phone:609-926-5451
Practice Address - Fax:609-926-1372
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05436700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1534904Medicaid
NJ653547Medicare ID - Type Unspecified
NJE73080Medicare UPIN