Provider Demographics
NPI:1194992834
Name:BEZZERIDES, VASSILIOS JAMES (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:VASSILIOS
Middle Name:JAMES
Last Name:BEZZERIDES
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 1:300 LONGWOOD AVE
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON, HOUSE STAFF LOUNGE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6363
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE # ENDERS12
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-919-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229151208000000X
MA239833207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics