Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | NH123 | NH |
NPI | 1205832391 |
---|---|
Provider Name | Dr. Chris C. Panagoulias |
First Address | Ogunquit, ME 03907-3647 |
Second Address | Nashua, NH 03060-3314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 09/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0308235Y0NH01 | ANTHEM (01) | NH |
713977 | TUFTS HEALTH PLAN (01) | NH |
T25722 | (02) | NH |