Provider Demographics
NPI:1154390995
Name:AVRADOPOULOS, KONSTANTINO A (MD)
Entity type:Individual
Prefix:
First Name:KONSTANTINO
Middle Name:A
Last Name:AVRADOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4000
Mailing Address - Country:US
Mailing Address - Phone:508-764-6966
Mailing Address - Fax:508-764-2457
Practice Address - Street 1:94 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4000
Practice Address - Country:US
Practice Address - Phone:508-764-6966
Practice Address - Fax:508-764-2457
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204941208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8052669OtherCIGNA HEALTH PLAN
042472266OtherHEALTHCARE VALUE MANAGMEN
3700043OtherEVERCARE
45955OtherCHILDRENS MEDICAL SECURIT
AA8132OtherHARVARD PILGRIM HEALTHCAR
J22103OtherBLUE SHIELD INDEMNITY
3207048OtherHEALTHY START
935195OtherFIRST HEALTH
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
MA3207048Medicaid
45865OtherFALLON COMMUNITY HEALTH P
5605292OtherAETNA US HEALTHCARE
A30735OtherMEDICARE B
3207048OtherMEDICAID WELFARE
783988OtherMVP HEALTH CARE
J22103OtherBLUE CARE ELECT
J22103OtherBLUE SHIELD HMO BLUE
3207048OtherHEALTHY START
AA8132OtherHARVARD PILGRIM HEALTHCAR