Provider Demographics
NPI:1922398205
Name:KETONIS, CONSTANTINOS (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CONSTANTINOS
Middle Name:
Last Name:KETONIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE, BOX 665
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-275-6970
Mailing Address - Fax:585-273-3297
Practice Address - Street 1:601 ELMWOOD AVE,
Practice Address - Street 2:BOX 665
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-275-6970
Practice Address - Fax:585-273-3297
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291118207XS0106X, 207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program