Provider Demographics
NPI:1841750809
Name:GEORGIADIS, KATHRYN (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:GEORGIADIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SUMMER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5315
Mailing Address - Country:US
Mailing Address - Phone:203-324-4109
Mailing Address - Fax:203-969-1271
Practice Address - Street 1:1275 SUMMER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5315
Practice Address - Country:US
Practice Address - Phone:718-741-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT070809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program