Provider Demographics
NPI:1124309901
Name:SPANOS, CONSTANTINE (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:
Last Name:SPANOS
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 1:15 FITZIOU
Mailing Address - Street 2:N 751
Mailing Address - City:PANORAMA-THESSALONIKI
Mailing Address - State:NORTHERN GREECE
Mailing Address - Zip Code:55236
Mailing Address - Country:GR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 FITZIOU
Practice Address - Street 2:N 751
Practice Address - City:PANORAMA-THESSALONIKI
Practice Address - State:NORTHERN GREECE
Practice Address - Zip Code:55236
Practice Address - Country:GR
Practice Address - Phone:01130231-033-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78668208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery