1144240243 NPI number — THOMAS P. ZAVITSANOS M.D.

Table of content: (NPI 1407212525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144240243 NPI number — THOMAS P. ZAVITSANOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAVITSANOS
Provider First Name:
THOMAS
Provider Middle Name:
P.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144240243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8500-6335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-807-8000
Provider Business Mailing Address Fax Number:
215-807-8235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3998 RED LION RD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-612-4060
Provider Business Practice Location Address Fax Number:
215-612-2630
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD041904E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: MD041904E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0012020000002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810454462 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012020000005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012020000001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012020000006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30002953 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 605367 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 050090775 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1134679 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3056444 . This is a "AETNA CONTRACT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30070979 . This is a "KEYSTONE MERCY - PM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 605367 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01202000-05 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0427892000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1330666 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1242712 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com