Provider Demographics
NPI:1881744480
Name:KONSTAS, ANGELOS ARISTEIDIS (MD, PHD)
Entity type:Individual
Prefix:
First Name:ANGELOS
Middle Name:ARISTEIDIS
Last Name:KONSTAS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N 1ST AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7027
Mailing Address - Country:US
Mailing Address - Phone:626-821-1411
Mailing Address - Fax:626-447-1058
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-5139
Practice Address - Fax:626-447-1058
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2772452085R0202X, 2085N0700X
CAA1147612085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1147610Medicaid
CACB252396Medicare PIN
CACB228884Medicare PIN
CAEZ249ZMedicare PIN
CACB228886Medicare PIN
CACB228887Medicare PIN
CACB238303Medicare PIN
CA0A1147610Medicaid