Basic Information
| Provider Information | |||||||||
| NPI: | 1497990485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIANOUKOS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 CANTON ST. | ||||||||
| Address2: | SUITE 325 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020902329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814077713 | ||||||||
| FaxNumber: | 7814070998 | ||||||||
| Practice Location | |||||||||
| Address1: | 736 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021352907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177892782 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2008 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 252597 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 252597 | MA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | AA324196 | 01 | HARVARD PILGRIM | OTHER | 110097035A | 05 | MA | MEDICAID | 3090768 | 05 | NH | MEDICAID |