Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 181866 | NY |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 181866 | NY |
N | 2080N0001X | Neonatal-Perinatal Doctor | 181866 | NY |
NPI | 1083644132 |
---|---|
Provider Name | Mr. Dimitrios S Mastrogiannis |
First Address | Syracuse, NY 13212-4516 |
Second Address | Syracuse, NY 13202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 14/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01464295 | (05) | NY |
036.136742 | (05) | IL |
E22894 | (02) | NY |