Provider Demographics
NPI:1356342653
Name:PANOPOULOS, JOHN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:PANOPOULOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845343
Mailing Address - Street 2:PORTSMOUTH ANESTHESIA ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-5343
Mailing Address - Country:US
Mailing Address - Phone:800-720-1664
Mailing Address - Fax:207-753-2020
Practice Address - Street 1:333 BORTHWICK AVENUE
Practice Address - Street 2:PORTSMOUTH ANESTHESIA ASSOCIATES
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-749-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH10491174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30220121Medicaid
NHF44600Medicare UPIN
NHRE5077Medicare ID - Type Unspecified
NH30220121Medicaid