Provider Demographics
NPI:1386631844
Name:HASIOTIS, GEORGE A (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:HASIOTIS
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 1:65 E INDIA ROW
Mailing Address - Street 2:#32A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3308
Mailing Address - Country:US
Mailing Address - Phone:617-367-6366
Mailing Address - Fax:508-778-9677
Practice Address - Street 1:65 E INDIA ROW
Practice Address - Street 2:#32A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3308
Practice Address - Country:US
Practice Address - Phone:617-367-6366
Practice Address - Fax:508-778-9677
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0137863Medicaid
MAM06139Medicare ID - Type Unspecified
MA0137863Medicaid