Provider Demographics
NPI:1184905697
Name:TOURNAS, ATHANASIOS (MD)
Entity type:Individual
Prefix:
First Name:ATHANASIOS
Middle Name:
Last Name:TOURNAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 GUY PARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1043
Mailing Address - Country:US
Mailing Address - Phone:518-770-7830
Mailing Address - Fax:518-770-7805
Practice Address - Street 1:425 GUY PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1043
Practice Address - Country:US
Practice Address - Phone:518-770-7830
Practice Address - Fax:518-770-7805
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268672207Y00000X, 207YS0123X
VA0101249529207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101249529OtherSTATE LICENSE
NY268672OtherSTATE LICENSE