Basic Information
| Provider Information | |||||||||
| NPI: | 1326011180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMETROULAKOS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 ENDICOTT ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019233623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816393055 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 104 ENDICOTT ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DANVERS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019233623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787456601 | ||||||||
| FaxNumber: | 9786244040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 79502 | MA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1000021 | 01 | MA | UNITED HEALTH NUMBER | OTHER | 19486 | 01 | MA | HARVARD PILGRIM | OTHER | 2084343 | 01 | MA | AETNA | OTHER | 0012294 | 01 | MA | NEIGHBORHOOD HEALTH NUMBE | OTHER | 040006919 | 01 | MA | RAILROAD MEDICARE NUMBER | OTHER | 3129101 | 05 | MA | MEDICAID | 079502 | 01 | MA | TUFTS NUMBER | OTHER | 34544 | 01 | MA | FALLON NUMBER | OTHER | J30549 | 01 | MA | BLUE SHIELD NUMBER | OTHER |