Individual provider Active NPI

Stephanie Papaconstantinou, MD

  • Family Medicine Physician
  • Champlain, NY
National Provider Identifier
1184286254
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
318297 Issued in NY
Practice address
828 State Route 11
Champlain, NY 12919-4966
Phone
(518) 298-2691
Fax
(518) 298-8241
NPI assigned
Jun 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 318297 NY Primary

Addresses

Primary practice location

828 State Route 11
Champlain, NY 12919-4966

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stephanie.papaconstantinou.1@1823.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
318297NYMDNursing Care Agency

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665619200000",
    "number": "1184286254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 STATE ROUTE 11",
            "city": "CHAMPLAIN",
            "state": "NY",
            "postal_code": "129194966",
            "telephone_number": "518-298-2691",
            "fax_number": "518-298-8241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAPACONSTANTINOU",
        "first_name": "STEPHANIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "318297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stephanie.papaconstantinou.1@1823.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "828 State Route 11",
            "city": "Champlain",
            "state": "NY",
            "country_code": "US",
            "postal_code": "129194966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Champlain, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.