Provider Demographics
NPI:1265434526
Name:CONSTANTINOU, EUGENE C (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:C
Last Name:CONSTANTINOU
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 1:555 WILLARD AVE
Mailing Address - Street 2:DEPT OF VETERANS AFFAIRS
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2631
Mailing Address - Country:US
Mailing Address - Phone:866-808-7921
Mailing Address - Fax:860-667-6875
Practice Address - Street 1:555 WILLARD AVE
Practice Address - Street 2:DEPT OF VETERANS AFFAIRS
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2631
Practice Address - Country:US
Practice Address - Phone:866-808-7921
Practice Address - Fax:860-667-6875
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001396896Medicaid
CT110008426Medicare ID - Type Unspecified
G93729Medicare UPIN