Provider Demographics
NPI:1861474215
Name:BOUSSIOTIS, VASSILIKI A (MD PHD)
Entity Type:Individual
Prefix:
First Name:VASSILIKI
Middle Name:A
Last Name:BOUSSIOTIS
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:100 BLOSSOM ST
Practice Address - Street 2:HEMATOLOGY ONCOLOGY ASSOCIATES COX 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2606
Practice Address - Country:US
Practice Address - Phone:617-724-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220011207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2096030Medicaid
MA470044OtherTUFTS HEALTH PLAN
MAJ28375OtherBCBS MA
MAA38046Medicare ID - Type Unspecified
MAJ28375OtherBCBS MA