Provider Demographics
NPI:1083658686
Name:KOTZAMPALTIRIS, PAUL (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KOTZAMPALTIRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-0005
Mailing Address - Country:US
Mailing Address - Phone:508-655-0636
Mailing Address - Fax:508-655-0665
Practice Address - Street 1:115 LINCOLN STREET
Practice Address - Street 2:METROWEST MEDICAL CENTER
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-655-0636
Practice Address - Fax:508-655-0665
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA208732207P00000X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001833901Medicare PIN