Provider Demographics
NPI:1659875029
Name:CANAKIS, ANDREW GERASIMOS
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:GERASIMOS
Last Name:CANAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE BOSTON MEDICAL CENTER PL
Mailing Address - Street 2:SHAPIRO CLINIC, 6TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5951
Mailing Address - Fax:
Practice Address - Street 1:ONE BOSTON MEDICAL CENTER PL
Practice Address - Street 2:SHAPIRO CLINIC, 6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-11-11
Deactivation Date:2018-03-21
Deactivation Code:
Reactivation Date:2018-03-27
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2024-00982207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program