Provider Demographics
NPI:1881634632
Name:YANNOPOULOS, ARIS D (MD)
Entity Type:Individual
Prefix:
First Name:ARIS
Middle Name:D
Last Name:YANNOPOULOS
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 1:1111 CROMWELL AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3455
Mailing Address - Country:US
Mailing Address - Phone:860-525-4469
Mailing Address - Fax:860-278-8032
Practice Address - Street 1:1111 CROMWELL AVE STE 404
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:860-525-4469
Practice Address - Fax:860-278-8032
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030012207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0384440001OtherDMERC
CT001300128Medicaid
200025355OtherRAILROAD MEDICARE
200025355OtherRAILROAD MEDICARE
200000458Medicare ID - Type Unspecified