Provider Demographics
NPI:1780912790
Name:SOURPIS, ANGELOS (MD)
Entity type:Individual
Prefix:MR
First Name:ANGELOS
Middle Name:
Last Name:SOURPIS
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 1:300 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3658
Mailing Address - Country:US
Mailing Address - Phone:617-469-0300
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3658
Practice Address - Country:US
Practice Address - Phone:617-469-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2428772084P0800X
MA217976 EXP06/30/20072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry