Provider Demographics
NPI:1245323641
Name:YANNOPOULOS, PANAYOTES (MD)
Entity type:Individual
Prefix:
First Name:PANAYOTES
Middle Name:
Last Name:YANNOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:YANNOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1825 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614
Mailing Address - Country:US
Mailing Address - Phone:203-370-5493
Mailing Address - Fax:203-380-0874
Practice Address - Street 1:1825 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614
Practice Address - Country:US
Practice Address - Phone:203-370-5493
Practice Address - Fax:203-380-0874
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1003334Medicaid
CTF15984Medicare UPIN
CT1003334Medicaid