Provider Demographics
NPI:1386806867
Name:ELISSEOU, NICHOLAS M (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:ELISSEOU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2907
Mailing Address - Country:US
Mailing Address - Phone:617-779-6500
Mailing Address - Fax:617-779-6557
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-779-6500
Practice Address - Fax:617-779-6557
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2020-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2814302086S0105X
KY508702086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand