Provider Demographics
NPI:1821075789
Name:GEORGE P MELTSAKOS PC
Entity Type:Organization
Organization Name:GEORGE P MELTSAKOS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MELTSAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-458-9651
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-458-9651
Mailing Address - Fax:978-970-0378
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 504
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-458-9651
Practice Address - Fax:978-970-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785639Medicaid
MA9785639Medicaid
MAE50272Medicare UPIN