Provider Demographics
NPI:1326011180
Name:DEMETROULAKOS, JAMES L (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:DEMETROULAKOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:104 ENDICOTT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:781-639-3055
Mailing Address - Fax:
Practice Address - Street 1:104 ENDICOTT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-745-6601
Practice Address - Fax:978-624-4040
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA79502207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1000021OtherUNITED HEALTH NUMBER
MA19486OtherHARVARD PILGRIM
MA2084343OtherAETNA
MA0012294OtherNEIGHBORHOOD HEALTH NUMBE
MA040006919OtherRAILROAD MEDICARE NUMBER
MA3129101Medicaid
MA079502OtherTUFTS NUMBER
MA34544OtherFALLON NUMBER
MAJ30549OtherBLUE SHIELD NUMBER
MA19486OtherHARVARD PILGRIM
MA2084343OtherAETNA