Provider Demographics
NPI:1205925179
Name:PANTELAKIS, NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:PANTELAKIS
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 1:44 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3466
Mailing Address - Country:US
Mailing Address - Phone:978-465-7903
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-531-4848
Practice Address - Fax:978-531-6036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA033413OtherTUFTS HEALTH
MA93625OtherAETNA
MA13387OtherHARVARD-PILGRIM
MA002009OtherONE HEALTH
MA329847OtherUNITED HEALTHCARE
MA39291OtherFALLON
MA993595OtherNETWORK HEALTH
MAMO8620OtherBCBS
MA199310OtherCIGNA
MA199310OtherHEALTHSOURCE
MA2027356Medicaid
MA329847OtherUNITED HEALTHCARE