Provider Demographics
NPI:1871551978
Name:CONSTANTINOU, CONSTANTINOS A (MD)
Entity type:Individual
Prefix:
First Name:CONSTANTINOS
Middle Name:A
Last Name:CONSTANTINOU
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 1:94 UNION ST
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3131
Mailing Address - Country:US
Mailing Address - Phone:860-870-1300
Mailing Address - Fax:860-870-1306
Practice Address - Street 1:94 UNION ST
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3131
Practice Address - Country:US
Practice Address - Phone:860-870-1300
Practice Address - Fax:860-870-1306
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240098208G00000X
CT043819208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001438193Medicaid
CT330000141Medicare PIN
I20602Medicare UPIN