Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101249529 | VA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 268672 | NY |
Y | 207YS0123X | Facial Plastic Surgeon | 268672 | NY |
NPI | 1184905697 |
---|---|
Provider Name | Athanasios Tournas |
First Address | Amsterdam, NY 12010-1043 |
Second Address | Amsterdam, NY 12010-1043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2011 |
Last Update Date | 16/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101249529 | STATE LICENSE (01) | VA |
268672 | STATE LICENSE (01) | NY |