Provider Demographics
NPI:1881948271
Name:TZORTZIS, GEORGE JOHN
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JOHN
Last Name:TZORTZIS
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 1:131 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1541
Mailing Address - Country:US
Mailing Address - Phone:978-836-6522
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-8504
Practice Address - Country:US
Practice Address - Phone:781-932-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26598183500000X
MANU265981835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear