Provider Demographics
NPI:1891130845
Name:SPIROS MITSOPOULOS, MD, PLLC
Entity Type:Organization
Organization Name:SPIROS MITSOPOULOS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPIROS
Authorized Official - Middle Name:
Authorized Official - Last Name:MITSOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-663-8230
Mailing Address - Street 1:445 CYPRESS ST
Mailing Address - Street 2:UNIT 9
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3600
Mailing Address - Country:US
Mailing Address - Phone:603-663-8230
Mailing Address - Fax:603-663-8239
Practice Address - Street 1:445 CYPRESS ST
Practice Address - Street 2:UNIT 9
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3600
Practice Address - Country:US
Practice Address - Phone:603-663-8230
Practice Address - Fax:603-663-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHB86181Medicare UPIN