Basic Information
| Provider Information | |||||||||
| NPI: | 1407827033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TSIKITAS | ||||||||
| FirstName: | BILL | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MARINA DR | ||||||||
| Address2: | APT. 604 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021711531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174812005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 FOGG RD | ||||||||
| Address2: | HOSPITALIST PROGRAM | ||||||||
| City: | SOUTH WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021902432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813408744 | ||||||||
| FaxNumber: | 7816825627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 158826 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 158826 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 00838486 | 05 | NY | MEDICAID |