Provider Demographics
NPI:1073804126
Name:VALAVANIS, KATERINA C (MD)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:C
Last Name:VALAVANIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATERINA
Other - Middle Name:C
Other - Last Name:NACOPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 W CHEW ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5549
Practice Address - Country:US
Practice Address - Phone:610-969-3500
Practice Address - Fax:610-969-3509
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine