Provider Demographics
NPI:1396735585
Name:FIDIAS, PANAGIOTIS MIHALIS (MD)
Entity type:Individual
Prefix:DR
First Name:PANAGIOTIS
Middle Name:MIHALIS
Last Name:FIDIAS
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 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2937
Mailing Address - Country:US
Mailing Address - Phone:603-580-6753
Mailing Address - Fax:603-580-6840
Practice Address - Street 1:5 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2128
Practice Address - Country:US
Practice Address - Phone:603-580-7054
Practice Address - Fax:603-580-6747
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77854207RH0000X, 207RX0202X
AZ49332207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19643OtherBCBS MA
NH3080576Medicaid
MA3188001Medicaid
MA077854OtherTUFTS HEALTH PLAN
MA077854OtherTUFTS HEALTH PLAN