Provider Demographics
NPI:1174232144
Name:KOTSOPOULOS, EVA (NP)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:KOTSOPOULOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VINE ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3120
Mailing Address - Country:US
Mailing Address - Phone:774-249-3739
Mailing Address - Fax:
Practice Address - Street 1:18 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6668
Practice Address - Country:US
Practice Address - Phone:207-922-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221549207VG0400X, 207VC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology