Individual
DR. OTHON ILIOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 BLOSSOM STREET, YAW 7 MASSACHUSETTS GENERAL HOSPITAL, BOSTON, MA 02114-2617
(617) 724-3404
(617) 726-8623
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-3404
(617) 726-8623
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
76267
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0117749
—
MA
01
—
076267
TUFTS HEALTH PLAN
MA
01
—
J12656
BCBS MA
MA
Enumeration date
09/01/2006
Last updated
12/18/2012
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