Provider Demographics
NPI:1992797195
Name:TRAVIAS, VLASSIS (MD)
Entity type:Individual
Prefix:
First Name:VLASSIS
Middle Name:
Last Name:TRAVIAS
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 1:59 ORNAC
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3317
Mailing Address - Country:US
Mailing Address - Phone:978-369-7627
Mailing Address - Fax:978-371-2240
Practice Address - Street 1:59 ORNAC
Practice Address - Street 2:SUITE 1
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3317
Practice Address - Country:US
Practice Address - Phone:978-369-7627
Practice Address - Fax:978-371-2240
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210620207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0158968Medicaid
MA0158968Medicaid
MAH51622Medicare UPIN