Provider Demographics
NPI:1639751407
Name:PAPATHANASIOU, KOSTANTINOS CHRISTOS
Entity type:Individual
Prefix:
First Name:KOSTANTINOS
Middle Name:CHRISTOS
Last Name:PAPATHANASIOU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 BURROUGHS RD
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1916
Mailing Address - Country:US
Mailing Address - Phone:978-621-1937
Mailing Address - Fax:
Practice Address - Street 1:819 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01151-1045
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77572207Q00000X
MA1014794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine