Provider Demographics
NPI:1891730982
Name:THEODOSIOU, ELENA NIKOU (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:NIKOU
Last Name:THEODOSIOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BORTHWICK AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7156
Mailing Address - Country:US
Mailing Address - Phone:603-433-5226
Mailing Address - Fax:603-433-4939
Practice Address - Street 1:155 BORTHWICK AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7156
Practice Address - Country:US
Practice Address - Phone:603-433-5226
Practice Address - Fax:603-433-4939
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016524207RH0003X
NY290174207RH0003X
NH16333207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3092047Medicaid
NHRAILROAD P01287489Medicare PIN
NHT400108184Medicare PIN
MEI11962Medicare UPIN
NHT400108184Medicare PIN
NHP01287489OtherRAILROAD MEDICARE
NH3092047Medicaid
WI102472200Medicare PIN